In-hospital cardiac arrest

Area of Science:

• Emergency Medicine
• Cardiology
• Critical Care

Background:

• The modern era of cardiopulmonary resuscitation (CPR) began over 40 years ago.
• Despite advancements, secure evidence of improved outcomes for adult in-hospital cardiac arrest remains limited.

Purpose of the Study:

• To review the current management of in-hospital cardiac arrest.
• To identify variables influencing outcomes of adult CPR in hospital settings.

Main Methods:

• Searched OLDMEDLINE (1950-1966) and MEDLINE (1966-2005) using keywords: cardiopulmonary resuscitation, cardiac arrest, in hospital, adult.
• Included secondary sources from review publications and personal communications.

Main Results:

• No secure evidence shows improved ultimate outcomes for in-hospital cardiac arrest CPR over 40 years.
• Paucity of objective measurements impedes secure protocols for intervention sequencing and CPR initiation/discontinuation.
• Physician and nursing preparedness to implement guidelines has been questioned.
• Automated external defibrillators show no proven benefit for in-hospital CPR by first responders, unlike out-of-hospital settings.
• Advanced life support providers achieve greater success, particularly with prompt electrical defibrillation by trained personnel in monitored critical care settings.

Conclusions:

• Significant improvements in adult in-hospital cardiac arrest outcomes are not well-supported by evidence.
• Lack of objective data, inconsistent guideline adherence, and questions about preparedness are key challenges.
• Prompt defibrillation by expert teams in monitored critical care units, like coronary care units, improves outcomes.