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CE Article

Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience

Corresponding author: Mary Boyde, School of Nursing and Midwifery, University of Queensland, Second Floor, Building One, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland 4102, Australia (e-mail: m.boyde{at}uq.edu.au).

Background Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training.

Objectives To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest.

Methods An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model.

Results Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge.

Conclusions The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.

Notice to CE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: Discuss use of the Utstein template to determine clinical variables that improve in-hospital cardiac arrest survival. Discuss collection of cardiac arrest data at a 750-bed tertiary referral hospital in Brisbane, Australia. Correlate clinical variables that improve survival from in-hospital cardiac arrest as evidenced by return of spontaneous circulation and survival to hospital discharge. To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue."

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