Matthew D McEvoy1, Larry C Field2, Haley E Moore3, Jeremy C Smalley4, Paul J Nietert5, Sheila H Scarbrough6. 1. Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232, United States. 2. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, United States. Electronic address: field@musc.edu. 3. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, United States. 4. Department of Orthopedics, Medical University of South Carolina, Charleston, SC 29425, United States. 5. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States. 6. Critical Interventions Manager, Medical University of South Carolina, Charleston, SC 29425, United States.
Abstract
AIM: Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC). METHODS: A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC. RESULTS: In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p<0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p<0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p<0.01 and p<0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs. CONCLUSIONS: Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.
AIM: Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC). METHODS: A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC. RESULTS: In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p<0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p<0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p<0.01 and p<0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs. CONCLUSIONS: Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.
Authors: Diane B Wayne; Monica J Fudala; John Butter; Viva J Siddall; Joe Feinglass; Leonard D Wade; William C McGaghie Journal: Acad Med Date: 2005-10 Impact factor: 6.893
Authors: Miguel Antonio Moretti; Luiz Antonio Machado Cesar; Amit Nusbacher; Karl B Kern; Sergio Timerman; José Antonio Franchini Ramires Journal: Resuscitation Date: 2007-03 Impact factor: 5.262
Authors: J H Silber; S K Kennedy; O Even-Shoshan; W Chen; L F Koziol; A M Showan; D E Longnecker Journal: Anesthesiology Date: 2000-07 Impact factor: 7.892
Authors: Jianmin Tian; David A Kaufman; Stuart Zarich; Paul S Chan; Philip Ong; Yaw Amoateng-Adjepong; Constantine A Manthous Journal: Am J Respir Crit Care Med Date: 2010-04-22 Impact factor: 21.405
Authors: Diane B Wayne; Aashish Didwania; Joe Feinglass; Monica J Fudala; Jeffrey H Barsuk; William C McGaghie Journal: Chest Date: 2007-06-15 Impact factor: 9.410
Authors: Saket Girotra; Brahmajee K Nallamothu; John A Spertus; Yan Li; Harlan M Krumholz; Paul S Chan Journal: N Engl J Med Date: 2012-11-15 Impact factor: 91.245
Authors: Matthew D McEvoy; Jeremy C Smalley; Paul J Nietert; Larry C Field; Cory M Furse; John W Blenko; Benjamin G Cobb; Jenna L Walters; Allen Pendarvis; Nishita S Dalal; John J Schaefer Journal: Simul Healthc Date: 2012-08 Impact factor: 1.929
Authors: Larry C Field; Matthew D McEvoy; Jeremy C Smalley; Carlee A Clark; Michael B McEvoy; Horst Rieke; Paul J Nietert; Cory M Furse Journal: Resuscitation Date: 2013-09-19 Impact factor: 5.262
Authors: Ali O Malik; Brahmajee K Nallamothu; Brad Trumpower; Marci Kennedy; Sarah L Krein; Khaja M Chinnakondepalli; Vittal Hejjaji; Paul S Chan Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-17
Authors: Peter M Hession; Cynthia J Millward; Joyce E Gottesfeld; Thomas F Rehring; Kevin B Miller; Paul M Chetham; S Kel Muckleroy; Christopher A Bates; Harris W Hollis Journal: Perm J Date: 2016-08-17
Authors: Samuel O Clarke; Ian M Julie; Aubrey P Yao; Heejung Bang; Joseph D Barton; Sameerah M Alsomali; Matthew V Kiefer; Ali Hasan Al Khulaif; Muna Aljahany; Sandhya Venugopal; Aaron E Bair Journal: BMJ Simul Technol Enhanc Learn Date: 2018-03-02
Authors: Catherine E Ross; Ari Moskowitz; Anne V Grossestreuer; Mathias J Holmberg; Lars W Andersen; Tuyen T Yankama; Robert A Berg; Amanda O'Halloran; Monica E Kleinman; Michael W Donnino Journal: Resuscitation Date: 2020-11-02 Impact factor: 5.262
Authors: G Akdemir; I M Markusse; Y P M Goekoop-Ruiterman; G M Steup-Beekman; B A M Grillet; P J S M Kerstens; W F Lems; T W J Huizinga; C F Allaart Journal: Clin Rheumatol Date: 2016-09-28 Impact factor: 2.980