The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community*,**

https://doi.org/10.1016/S0196-0644(94)70009-5Get rights and content

Study objective: To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest.

Design: A retrospective case review of all patients in cardiac arrest during a 13-month period before and after the institution of an ACLS training program.

Setting: Emergency department of a 42-bed rural, community hospital in a community with no prehospital advanced life support or early defibrillation.

Participants: All patients in cardiac arrest were entered into the data base. Twenty-nine patients were included in the pre-ACLS period and 35 in the post-ACLS period. There were no significant differences in age, gender, initial rhythm, comorbid diseases, witnessed versus unwitnessed arrest, or total arrest time in the patients in the pre-ACLS period compared with those in the post-ACLS period.

Intervention: ACLS provider training.

Main results: Patients in cardiac arrest who had ventricular fibrillation/tachycardia as their initial rhythm had significant improvement in resuscitation success compared with patients in ventricular fibrillation/tachycardia in the pre-ACLS period (six of 15 versus none of nine, P<.05). Out-of-hospital cardiac arrest resuscitation was more successful in the post-ACLS period than in the pre-ACLS period (five of 30 versus none of 25, P<.05). Overall, seven of 35 patients (20%) were resuscitated successfully in the post-ACLS period, with two patients surviving to hospital discharge. This was not significantly different than the two of 29 patients (7%) resuscitated in the pre-ACLS period, with one patient surviving to discharge.

Conclusion: The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.

Section snippets

INTRODUCTION

The advanced cardiac life support (ACLS) course was developed by the American Heart Association to improve the outcome for cardiac arrest victims.1 Emergency medical services agencies, medical schools, hospitals, and insurance companies have required ACLS training for health care providers, based on the assumption that such training will improve resuscitation from cardiac arrest. Evaluations of the effectiveness of ACLS training generally have focused on knowledge acquisition or skills

MATERIALS AND METHODS

In October 1989 a 42-bed rural community hospital held the first ACLS-provider training program for its staff in ten years. Before this course, none of the physicians and approximately 15% of the nurses and physician's assistants were certified in ACLS. The ACLS course trained approximately 70% of the nursing and physician's assistant staff and 50% of the physician staff. Prehospital care is provided only by emergency medical technicians (EMTs) with no defibrillation capabilities. During the

RESULTS

Overall, 29 patients suffered cardiac arrest in the pre-ACLS period, with two patients (7%) resuscitated successfully and transferred to urban medical centers. One patient survived to hospital discharge. In the period following the ACLS course, seven of 35 patients (20%) were resuscitated successfully and transferred to urban medical centers, with two patients surviving to hospital discharge (Figure). These overall differences are not statistically significant.

Figure. Resuscitation rates from

DISCUSSION

The ACLS course was developed by the American Heart Association to improve resuscitation from cardiac arrest. Although ACLS training has been widely accepted, few studies have addressed whether this educational program can make a difference in the resuscitation of patients in cardiac arrest. Most of the literature evaluating ACLS training has focused on knowledge acquisition on "objective" written examinations and skill performance during simulated resuscitations. To improve outcome from

CONCLUSION

ACLS training was associated with higher resuscitation rates from cardiac arrests in a rural community. The major impact was for patients in ventricular fibrillation/tachycardia. The data in this study support the concept that ACLS training should be provided to all health care personnel treating patients in cardiac arrest.

References (10)

There are more references available in the full text version of this article.

Cited by (61)

  • Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

    2020, Resuscitation
    Citation Excerpt :

    We recognize that the evidence in support of this recommendation comes from observational studies of very low certainty. However, pooling of the available evidence consistently favors ALS training, and having ALS-trained staff present during an attempted adult resuscitation has been found to reduce treatment errors such as incorrect rhythm assessment337 and time to ROSC.341 We recognize that the provision of accredited adult ACLS training may not be feasible or appropriate in low-resource settings.

  • Simulation-based education and the challenge of transfer

    2019, Clinical Simulation: Education, Operations and Engineering
View all citing articles on Scopus
*

Presented at the Society for Academic Emergency Medicine Annual Meeting in Washington, DC, May 1991

**

Reprint no 47/1/52203

View full text