Evaluation of staff's retention of ACLS and BLS skills

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作者：Kimberly K. Smith ; Darlene Gilcreast ; Karen Pierce
关键词：Resuscitation ; CPR ; ACLS ; BLS
刊名：Resuscitation
出版年：2008
期刊代码：236_03009572
类别：med
出版时间：July 2008
卷：78
期：1
页码：59-65
文件大小：371 K

摘要

Prospective multicenter trial.

Setting

Patients treated by urban, suburban, and rural emergency medical services (EMS) services.

Patients

Eight hundred and seventy-four prehospital cardiac arrest patients.

Interventions

This group underwent conventional ACLS intervention followed by empiric early administration of sodium bicarbonate noting resuscitation times. Survival was measured as the presence of vital signs on emergency department (ED) arrival. Data analysis utilized Student's t-test and logistic regression (p < 0.05).

Results

Survival was improved with decreased time to BLS (5.52 min versus 6.81 min, p = 0.047) and ACLS (7.29 min versus 9.49 min, p = 0.002) intervention, as well as difference in time to return of spontaneous circulation (ROSC). The upper limit time interval after which no patient survived was 30 min for ACLS time, and 90 min for transport time. There was no overall difference in survival except at longer arrest times when considering the primary study intervention bicarbonate administration.

Conclusion

Delay to the initiation of BLS and ACLS intervention influenced outcome from prehospital cardiac arrest negatively. There were no survivors after prolonged delay in initiation of ACLS of 30 min or greater or total resuscitation and transport time of 90 min. This result was not influenced by giving bicarbonate, the primary study intervention, except at longer arrest times.

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Among all of the cathecolamines used for cardiac arrest treatment, epinephrine injection during cardio-pulmonary resuscitation is currently the most powerful means of enhancing effectiveness; however, deliberations about the optimal dosage have recently become intense. In the SAMU of Lyon (F), we conducted a double blind prospective randomized study over an 18-month period, comparing repeated standard-dose epinephrine (1 mg) and repeated high-dose epinephrine (5 mg) in the management of cardiac arrest outside the hospital. Five-hundred thirty-six patients were enrolled with 265 in the standard-dose group and 271 in the high-dose group; both groups are globally similar. One-hundred eighty-one (33.8%) patients returned to spontaneous circulation (R.O.S.C.); 85 in the standard-dose group (32%) and 96 in the high-dose group (35.5.%). One-hundred nineteen patients (22.2%) were admitted; 54 in the standard-dose group (20.4%) and 65 in the high-dose group (24%). At 6 months nine patients (7.6%) were alive; three patients from the standard-dose group (5.5%) and six from the high-dose group (9.2%). We never noticed cardiac or neurologic adverse effects with the high doses. The results of this study are not statistically significant, but we observed a marginal trend towards repeated 5 mg epinephrine doses. A large French multicentre study is now necessary.

In teaching hospitals the responsibility for cardiopulmonary resuscitation usually rests with the house-staff, yet most house-officers receive no formal training in life support. The life-support skills of 45 medical and surgical house-officers in a university teaching hospital were tested by means of simulated cardiac arrests. House-officers were graded on the basis of a performance checklist derived from the standards of the American Heart Association. No house-officer received a pass score in basic life support (BLS). Only 29%could properly compress and ventilate the mannequin. In advanced cardiac life support (ACLS) only one-third could intubate in 35 s or less; only 31%, 40%, and 33%could manage ventricular fibrillation, asystole, and complete heart block, respectively. Some house-officers were unable to operate the defibrillator or assemble resuscitation equipment. Many house-officers displayed helplessness and anxiety during the simulations; fourteen (40%) were prompted to register for additional advanced life-support courses. The performance of medical and surgical house-officers was equal. House-officers who had received prior life-support training performed better in BLS (p<0·001) but not in ACLS. It was concluded that (a) most medical and surgical house-officers are not reasonably proficient in BLS and ACLS, and (b) cardiac arrest simulation is a motivating exercise which permits analysis of each house-officer's life-support skills. House-officers should have more training and practice in life support, or they should not have primary responsibility for cardiopulmonary resuscitations.