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CARDIAC ARREST

A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy

A. Maziar Zafari, MD, PhD, FACC^*,, Susan K. Zarter, RN, Vicki Heggen, RN, Patricia Wilson, RN, MSN, Regina A. Taylor, RN, Kiran Reddy, BA^*,, Andrea G. Backscheider, PhD and Samuel C. Dudley, Jr, MD, PhD, FACC^*,,*

^* Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
Atlanta Veterans Administration Medical Center, Division of Cardiology, Atlanta, Georgia, USA
Atlanta Veterans Administration Medical Center, Health Services Research and Development, Atlanta, Georgia, USA

Manuscript received February 2, 2004; revised manuscript received March 25, 2004, accepted April 6, 2004.

^* Reprint requests and correspondence: Dr. Samuel C. Dudley, Jr., Division of Cardiology, Emory University/VAMC, 1670 Clairmont Road (111B), Decatur, Georgia (Email: sdudley{at}emory.edu).

OBJECTIVES: The purpose of this study was to determine whether survival to discharge after in-hospital cardiopulmonary arrest could be improved by a program encouraging early defibrillation that included switching from monophasic to biphasic devices.

BACKGROUND: In-hospital resuscitation continues to have a low success rate. Biphasic waveform devices have demonstrated characteristics that might improve survival, and outside the hospital, automated external defibrillators (AEDs) have shown promise in improving survival of patients suffering cardiopulmonary arrest.

METHODS: A program including education and replacement of all manual monophasic defibrillators with a combination of manual biphasic defibrillators used in AED mode and AEDs in all outpatient clinics and chronic care units was implemented.

RESULTS: With program implementation, the percentage survival of all patients with resuscitation events improved 2.6-fold, from 4.9% to 12.8%. Factors independently predicting survival included event location outside an intensive care unit, younger age, an initial rhythm of pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF), pre-arrest beta-blocker, and program initiation. The outcome was independent of gender, race, work shift, number of previous resuscitation attempts, body mass index, comorbidity index, presence of diabetes, presence of hypertension, or use of angiotensin-converting enzyme inhibitors. The improvement in mortality was attributable solely to an effect on patients presenting with VT/VF. Patients with these initial rhythms were 14-fold (odds ratio = 0.07 of death, confidence interval = 0.02 to 0.3) more likely to survive to discharge after program initiation. Automated external defibrillators performed similarly to biphasic manual defibrillators in AED mode.

CONCLUSIONS: A program including education and use of biphasic manual defibrillators in AED mode and selective use of AEDs improved survival to discharge in hospitalized patients suffering from cardiopulmonary arrest.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AED = automated external defibrillator   BMI = body mass index   CPR = cardiopulmonary resuscitation   DNR = Do Not Resuscitate   ICU = intensive care unit   VAMC = Veterans Administration Medical Center   VF = ventricular fibrillation   VT = ventricular tachycardia

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