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Quality assessment of defribrillation and advanced life support using data from the medical control module of the
K Sunde1, T Eftestøl, C Askenberg
1Norwegian Air Ambulance, Department of Research and Education in Acute Medicine, Drøbak. kjetil.sunde@ioks.uio.no
Insights
Analyzing defibrillation and advanced life support (ALS) in cardiac arrest patients revealed low survival rates. While shock success varied, only 4% achieved sustained return of spontaneous circulation (ROSC), highlighting areas for resuscitation quality improvement.
Area of Science:
- Cardiology
- Emergency Medicine
- Resuscitation Science
Background:
- The 'chain of survival' emphasizes timely defibrillation and advanced life support (ALS) for cardiac arrest patients.
- Understanding the effectiveness of these interventions is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the events during defibrillation and ALS in cardiac arrest patients.
- To evaluate the success rates of defibrillation and the impact of interventions on survival.
Main Methods:
- Studied 156 cardiac arrest patients of cardiac etiology using defibrillator computer recordings and Utstein-style data.
- Analyzed chest compression rates, compression-free periods, and time intervals between monitoring, compressions, and defibrillation.
- Assessed shock success rates, post-shock rhythms, and return of spontaneous circulation (ROSC).
Main Results:
- Only 6% of patients survived; 10% of shocks resulted in a pulse, and 4% in sustained ROSC.
- Median chest compression rate was 108/min, with shorter delays to compressions in asystole compared to electromechanical dissociation.
- A significant difference in the number of shocks was observed between survivors and non-survivors (1 vs. 7).
- Isoelectric periods followed 38% of shocks, with 27% lasting over 20 seconds.
Conclusions:
- Defibrillation and ALS interventions have limited success in achieving sustained ROSC in cardiac arrest.
- Detailed analysis of resuscitation events, including compression quality and post-shock rhythms, is vital for quality improvement.
- Further research is needed to optimize defibrillation and ALS protocols to enhance survival rates.
Abstract:
What actually occurred during the two last links in the 'chain of survival': defibrillation and advanced life support (ALS), was studied in 156 patients with cardiac arrest of cardiac aetiology using the computer recording of the defibrillator and the Utstein-style data record. Ten patients (6%) survived. The ECG artefacts caused by chest compressions enabled a detailed analysis of compression rates (median 108 min(-1)) and duration of important compression free periods. The time from initiation of monitoring during asystole until chest compressions were initiated was median 29 s, significantly shorter than during electromechanical dissociation (EMD, 109 s; P < 0.001). These times were both significantly longer than the median time from initiation of monitoring until the first shock was given in cases with VF (19 s; P < 0.001). A total of 883 shocks (median six shocks) were administered to 110 patients with a significant difference in number of shocks between survivors and non-survivors, one versus seven, respectively. The success rate for the first shock and all shocks defined as non-VT/VF 5 s after the shock, was 75 and 63%, respectively. However, just 10% of all shocks resulted in a rhythm with a pulse and only 4% resulted in sustained return of spontaneous circulation (ROSC). An isoelectric period followed 38% of the shocks, and in 27% this lasted more than 20 s, with five patients obtaining electrical activity with a pulse after more than 30 s of isoelectric ECG. Thoracic impedance did not affect the shock efficacy. The method of analysing resuscitation we describe may be useful for quality improvement.