Elsevier

Resuscitation

Volume 60, Issue 2, February 2004, Pages 137-142
Resuscitation

Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team

https://doi.org/10.1016/j.resuscitation.2003.09.007Get rights and content

Abstract

Objective: To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. Methods: This is a “three-phase” (organized, transitional, and re-organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re-organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age). Results: The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase (P=0.013). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re-organized teams (P=0.007). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods (P=0.406). The chance of survival-to-discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re-organized period (P=0.496). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35–4.80) and witness at the scene (odds ratio: 2.45, 95% confidence interval: 1.34–4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis. 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.

Sumàrio

Objectivo: Avaliar o impacto de uma equipa de reanimação estruturada e formal no departamento de emergência (DE), na taxa de sucesso da reanimação cardio-pulmonar (CPR) das vı́timas de paragem cardı́aca extra-hospitalar (OHCA). Métodos: Este é um estudo prospectivo em “três fases” (Organizar, transição, re-organizar), no qual foram revistos os registos médicos de todas as vı́timas de OHCA que necessitaram de reanimação no DE durante os 3 perı́odos de 6 meses, e os dados foram registados num formato estilo Utstein extra-hospitalar. Existia uma equipa de reanimação organizada nas fases organizar e re-organizar, mas não na fase de transição. Esta população de estudo consiste em adultos com paragem cardı́aca não traumática (>18 anos de idade). Resultados: As taxas de recuperação de circulação espontânea (ROSC) foram 51.3% para a fase de organização, 31% para a fase de transição, e 53.1% para a fase de re-organizar (P = 0.0013). As taxas de ROSC da PEA/Assı́stolia foram significativamente mais elevadas em perı́odos com equipas organizadas e re-organizadas (P = 0.007). As taxas de ROSC para os sub-grupos de Fibrilhação Ventricular (VF) e taquicardia ventricular sem pulso (VT) foram significativamente diferentes em todos os três perı́odos (P = 0.406). A hipótese de sobreviver à alta foi 9.2% no perı́odo organizar, 11.2% no perı́odo de transição, e 15.6% no perı́odo de re-organizar (P = 0.496). A existência de uma equipa de reanimação de emergência formal e estruturada no ED (taxa de diferença: 2.45, intervalo de confiança de 95%: 1.34–4.45) foram os únicos predictores independentes de ROSC com sucesso das vı́timas de OHCA por análise de regressão logı́stica multipla. Conclusão: A criação de uma equipa de reanimação de emergência estruturada e formal no ED está associada com um aumento da probabilidade de ROSC com sucesso das vı́timas de OHCA.

Resumen

Objetivos: Evaluar el impacto de un equipo de resucitación formal, estructurado en el departamento de emergencias (ED) en la tasa de éxitos de reanimación cardiopulmonar(CPR) para pacientes de paro cardı́aco extrahospitalario (OHCA). Métodos: Este es un estudio prospectivo de tres fases (organizada, de transición y reorganizada) en el cual se revisaron los registros médicos de todos los pacientes de OHCA que necesitaron reanimación en el departamento de emergencias (ED) durante los tres perı́odos de tres meses que revisamos y codificamos los datos en formatos en el estilo de Utstein extrahospitalario. En las fases organizada y reorganizada existı́a un equipo organizado de reanimación, no ası́ en la fase de transición. La población estudiada consistı́a en pacientes adultos con paro cardı́aco no traumático (edad >18 años). Resultados: Las tasas de retorno a circulación espontánea (ROSC) fueron de 51.3% para la fase organizada, 31.0% para la fase de transición, y 53.1% para la fase reorganizada (P = 0.013). Las tasas de ROSC de actividad eléctrica sin pulso (PEA)/ası́stole fueron significativamente altas en perı́odos con equipos organizados y reorganizados (P = 0.007). Las tasas de ROSC para los subgrupos fibrilación ventricular (VF) y taquicardia ventricular sin pulso (VT) en los 3 perı́odos no fueron significativamente diferentes (P = 0.406). La posibilidad de sobrevida al alta fue de 9.2% en el perı́odo organizado, 11.2% en el perı́odo de transición, y 15.6% en el periodo reorganizado (P = 0.496). La existencia de un equipo formal de resucitación de emergencia, estructurado en el ED (odds ratio: 2.56, 95% intervalo de confianza: 1.35–4.80) y un testigo en la escena (odds ratio: 2.45, 95% intervalo de confianza: 1.34–4.45) fueron los únicos factores independientes que predicen ROSC exitoso en pacientes con OHCA por análisis de regresión logı́stica. Conclusión: El establecimiento de un equipo de resucitación de emergencia formal y estructurado en el ED está asociado con una tasa aumentada de ROSC para pacientes de OHCA.

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.

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