A strategy for nurse defibrillation in general wards

Reducing the delay to defibrillation has a major impact on chance of survival from cardiac arrest. A high proportion of cardiac arrests occur in general ward areas, and the teaching and application of defibrillation is as much a priority there as in high dependency areas. The patients most likely to survive in-hospital cardiac arrests are those whom return of spontaneous circulation had been achieved by the first responder. In most clinical areas the first responder is likely to be a nurse. Nurses in Brighton had been taught manual defibrillation for many years, but were often reluctant to use their skills. We introduced a course specifically designed for ward nurses, covering rhythm recognition and defibrillation, with the objective of training large numbers and making the skill so prevalent that it would become an accepted nurse procedure.

Ninety-eight nurses were trained during 1996. By the end of that year, nurses in general ward areas performed defibrillation in 80% of all cases where a shock was required at any time during the resuscitation attempt. However, only 3/25 (12%) of patients in a primary shockable rhythm were defibrillated before a member of the cardiac arrest team arrived. One hundred and forty-nine additional nurses were trained during 1997/8. By the end of this two year period there was no increase in the overall percentage of nurse defibrillations, but the number of patients in primary VF/VT defibrillated before the arrival of the cardiac arrest team had markedly increased to 17/37 (46%, P < 0.02). During this period the overall hospital survival to discharge from primary VF/VT showed a non significant improvement from 41 to 55%.

We believe that it is not sufficient simply to permit nurse defibrillation, it must be perceived as a routine skill within the environment of an acute hospital.