Elsevier

Resuscitation

Volume 44, Issue 3, May 2000, Pages 165-169
Resuscitation

Early defibrillation and the chain of survival in ‘in-hospital’ adult cardiac arrest; minutes count

https://doi.org/10.1016/S0300-9572(00)00158-1Get rights and content

Abstract

Objective: To report the outcomes from and the impact of the chain of survival in ‘in-hospital’ cardiac arrest where the presenting rhythm was VF/VT, the arrest was witnessed, defibrillation was conducted rapidly and no other resuscitation interventions were required. Outcome measures: Any return of spontaneous circulation and discharge from hospital. Methods: A 2-year prospective resuscitation audit using the Utstein style was conducted within a major London NHS Hospital Group. Results: There were 124 patients who had primary VF/VT arrest. Eight were excluded from the study and 14 had non-witnessed cardiac arrest. Twenty one patients had witnessed VF/VT arrest but with delayed defibrillation, 81 patients had witnessed VF/VT arrest with rapid defibrillation, 69 patients had witnessed VF/VT arrest with rapid defibrillation, CPR and other additional interventions. There were 15 patients that had witnessed cardiac arrest with a presenting rhythm of VF/VT, who received rapid defibrillation and had no ventilation or chest compression prior to or following defibrillation. All 15 patients achieved a return of spontaneous circulation, and 12 were discharged alive. Conclusions: Rapid defibrillation prior to any other resuscitation intervention is associated with increased survival from witnessed VF/VT arrest in in-hospital cardiac arrest victims, and that the time to first shock is critical in enhancing the prospects of long-term survival in these patients.

Introduction

The impact of the ‘chain of survival’ and the importance of early defibrillation in the out-of-hospital arena is well documented [1]. Recent resuscitation literature alludes to the importance of early defibrillation within the ‘in-hospital’ situation [2], [3], [4], [5], [6]. The reports of outcomes from resuscitation in in-hospital cardiac arrest remain static [7], [8]. We present clinical data that demonstrates the importance of the ‘chain of survival’ concept [9] and the impact that early defibrillation has upon survival from in-hospital adult cardiac arrest.

Section snippets

Setting

The Hammersmith Hospitals NHS Trust compromises a group of hospitals situated in west London and is amongst the largest in the UK, containing ≈1200 ‘beds’. The group is composed of multi-disciplinary hospitals covering all aspects of medicine and surgery. It is distributed across four sites; two conventional hospitals, one obstetric hospital and a small elderly care unit. The hospital design is of the standard open plan wards, staffed by qualified nurses that are supported by trained ‘health

Results

During the 2-year period 1st April 1997 to 31st March 1999, there were 479 confirmed audited in-hospital cardiac arrests. There were 124 patients in whom the primary arrest rhythm was either ventricular fibrillation (VF) or ventricular tachycardia (VT). Fourteen of these patients had non-witnessed cardiac arrest and eight patients were excluded due to insufficient data. The remaining 102 patients had witnessed cardiac arrest. Twenty-one cases of witnessed VF/VT arrest had defibrillation

Discussion

The ‘chain of survival’ data (Table 3) correlates well with a previous study which used a very accurate timing system [11]. The results clearly indicate that a favourable outcome is significantly enhanced when rapid defibrillation is conducted for patients with witnessed VF/VT arrest and supports the consensus opinion regarding the importance of early defibrillation [12]. This data set indicates that even 1 or 2 min count and that any actions taken by resuscitation providers that leads to a

Acknowledgments

The authors would like to thank all of the medical, nursing and paramedical staff from the Hammersmith Hospital and Charing Cross Hospital who assisted in the data collection.

References (14)

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