Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team
Introduction
Out-of-hospital cardiac arrest (OHCA) is a potentially treatable state if resuscitation is started swiftly and effectively. Despite 40 years of research into cardiopulmonary resuscitation (CPR) therapies, overall survival rate after cardiac arrest remains poor [1].
Pre-hospital researchers have found advanced cardiac life support (ACLS) training to be related directly to the rate of survival. The automated external defibrillator (AED) used by emergency medical technicians (EMTs) in many countries has yielded excellent results in terms of the survival of patients with ventricular fibrillation (VF). Patients tend to have a poor prognosis if their initial rhythm is pulseless electrical activity (PEA)/asystole. As PEA/asystole is observed as the initial rhythm in more and more OHCA patients, increasing the rate of return of spontaneous circulation (ROSC) and survival becomes a serious and difficult challenge for the emergency physician [2].
Recent studies have revealed the benefits of medical emergency teams, which can significantly reduce the mortality of in-hospital resuscitation [3], [4], [5]. Our hospital has had an established resuscitation team for in-hospital cardiac arrests for many years [6]. However, the impact of the emergency resuscitation team in the ED for the OHCA patients was unclear. The purpose of this study is to determine whether a formal, structured resuscitation team could improve the ROSC rate in OHCA patients.
Section snippets
Materials and methods
We carried out a prospective investigation of OHCA patients in our hospital over three separate 6-month periods.
Results
There were 211 adult, non-traumatic OHCA patients with resuscitation in this study (Table 2). The mean age was 72.7±15.0 years (18–106 years), and 127 were male. Hypertension (78, 37.0%) was the most common underlying disease before resuscitation. The prevalence of diabetes mellitus was 25.1%, coronary artery disease was 31.8, and 15.2% had cancer. The time from patient collapse to being seen by an emergency technician was 13.5±12.6 min (5–89 min), and the time from patient collapse to arrival at
Discussion
OHCA is a serious, clinical event that carries a high mortality rate. Successful resuscitation requires early recognition of cardiopulmonary arrest, rapid activation of trained responders, timely CPR, defibrillation when indicated, and early use of advanced life support (ALS) [8], [9], [10].
In this three-period study, we found formal, structured emergency resuscitation teams to be strongly associated with increased ROSC in OHCA patients, although in both organized and transitional periods the
Conclusion
The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients especially those with an initial rhythm of PEA/asystole.
References (19)
- et al.
Evaluation of a hospital-wide resuscitation team: dose it increase survival for in-hospital cardiopulmonary arrest?
Resuscitation
(2001) - et al.
Factors influencing the outcomes after in-hospital resuscitation in Taiwan
Resuscitation
(2002) - et al.
Improving outcome from cardiac arrest in the hospital with a reorganized and strengthened chain of survival: an American view
Resuscitation
(1996) - et al.
In-hospital resuscitation: association between ACLS training and survival to discharge
Resuscitation
(2000) - et al.
Bystandard CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest
Ann. Emerg. Med.
(1995) - et al.
Factors affecting short- and long-term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity
Resuscitation
(2001) - et al.
Effects of external and internal factors on emergency department overcrowding
Ann. Emerg. Med.
(2002) - et al.
Hawthorne effect: implications for prehospital research
Ann. Emerg. Med.
(1995) - et al.
Resuscitation after cardiac arrest: a 3-phase time-sensitive model
J. Am. Med. Assoc.
(2002)
Cited by (31)
European Resuscitation Council Guidelines 2021: Adult advanced life support
2021, ResuscitationEffect of team-based cardiopulmonary resuscitation training for emergency medical service providers on pre-hospital return of spontaneous circulation in out-of-hospital cardiac arrest patients
2019, ResuscitationCitation Excerpt :To maximize the effects of CPR at the scene, a highly organized team is required to coordinate resuscitative efforts. Recent studies have reported that team-based CPR was associated with improved outcomes of OHCA patients, and thus, the active implementation of team-based CPR has been encouraged both in the field and at hospitals.6–8 In Korea, the EMS system, which provides basic-to-intermediate level of emergency services, is operated by the National Fire Agency.
Factors associated with survival after in-hospital cardiac arrest in Hong Kong
2013, American Journal of Emergency MedicinePart 12: Education, implementation, and teams: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :This makes it difficult to measure the effect of the debriefing. Evidence from one LOE 1 prospective RCT345 and 16 other studies (LOE 3–4)71,73,93,125,126,132,346–355 documented improvement with briefings/debriefings in the acquisition of the content knowledge, technical skills, and/or behavioral skills required for effective and safe resuscitation. One LOE 4 study356 revealed no effect of briefings/debriefings on performance.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation
2010, ResuscitationCitation Excerpt :Feedback tends to provide information about prior events and can use several methods (video recordings, defibrillator downloads or trained observer feedback). Debriefing appears to be an effective method for improving resuscitation performance and, potentially, patient outcomes as long as objective data forms the basis for the discussion.87,89,127,129,149,187,195–205 The ideal format for debriefing remains to be determined.