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The association between ACLS guideline deviations and outcomes from in-hospital cardiac arrest
Conor P Crowley1, Justin D Salciccioli1, Edy Y Kim2
1Critical Care Department, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge MA 02138, USA.
Insights
Adhering to Advanced Cardiovascular Life Support (ACLS) protocol is crucial for in-hospital cardiac arrest survival. Fewer deviations from ACLS guidelines significantly improve the chances of return of spontaneous circulation and survival to discharge.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Research
Background:
- In-hospital cardiac arrests (IHCA) are critical events with high morbidity and mortality.
- Current guidelines, such as Advanced Cardiovascular Life Support (ACLS), aim to standardize care during these events.
Purpose of the Study:
- To investigate the association between deviations from the established ACLS protocol and patient outcomes following in-hospital cardiac arrest.
Main Methods:
- A retrospective review of 108 patients experiencing cardiac arrest between December 2015 and November 2019 at a single academic medical center.
- Primary endpoint: return of spontaneous circulation (ROSC). Secondary endpoints: survival to discharge and favorable neurological outcome at discharge.
Main Results:
- Patients with return of spontaneous circulation had fewer ACLS deviations (median 1) compared to those without (median 6.5).
- ROSC rates decreased significantly with increasing protocol deviations (96% with 0-2 deviations, 11% with >6 deviations).
- Survival to discharge was higher with fewer deviations (median 0) versus more deviations (median 3).
Conclusions:
- Adherence to the ACLS protocol is critical for improving patient outcomes in cardiac arrest.
- Deviations from the ACLS algorithm are associated with reduced rates of ROSC and survival.
- Increased protocol deviations may correlate with poorer neurological outcomes post-cardiac arrest.
Aim Of Study:
In hospital cardiac arrests occur at a rate of 1-5 per 1000 admissions and are associated with significant morbidity and mortality. We aimed to investigate the association between deviations from ACLS protocol and patient outcomes.
Methods:
This retrospective review was conducted at a single academic medical center. Data was collected on patients who suffered cardiac arrest from December 2015-November 2019. Our primary endpoint was return of spontaneous circulation. Secondary endpoints included survival to discharge and discharge with favorable neurological outcomes.
Results:
108 patients were included, 74 obtained return of spontaneous circulation, and 23 survived to discharge. The median number of deviations from the ACLS protocol per event in ROSC group was 1 (IQR 0-3) compared to 6.5 (IQR 4-12) in non-ROSC group (p < .0001). The probability of obtaining ROSC was 96% with 0-2 deviations per event, 59% with 2-5 deviations per event, and 11% with greater than 6 deviations per event (p < .0001). The median deviation per event in patients who survived to discharge was 0 (IQR 0-1) vs. 3 (IQR 1-6, p < .0001) in those who did not. Lastly, survival to discharge with a favorable neurological outcome may be associated we less deviations per event (p < .006).
Conclusion:
Our findings highlight the importance of adherence to the ACLS protocol. We found that deviations from the algorithm are associated with decreased rates of ROSC and survival to discharge. Additionally, higher rates of protocol deviations may be associated with higher rates of neurological impairments after cardiac arrest.
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