Early defibrillation and the chain of survival in ‘in-hospital’ adult cardiac arrest; minutes count
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)
Fibrillation and defibrillation of the heart
Br. J. Anaesth.
(1997)- et al.
Recommended guidelines for reviewing, reporting and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’
Resuscitation
(1997) - et al.
Automatic external defibrillators in the hospital as well?
Resuscitation
(1996) - et al.
Student nurses can defibrillate within 90 seconds: an evaluation of a training programme for third year student nurse in the use of an automatic external defibrillator
Resuscitation
(1994) - et al.
Cardiac arrest and resuscitation: a tale of 29 cities
Ann. Emerg. Med.
(1990) - et al.
European Resuscitation Council guidelines for the use of automated external defibrillators by EMS providers and first responders
Resuscitation
(1998)
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