The early minutes of in-hospital cardiac arrest: Shock or CPR? A population based prospective study

Department of Anaesthesiology and Emergency Medicine, St. Olav University Hospital, Trondheim, Norway.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (Impact Factor: 2.03). 02/2008; 16(1):11. DOI: 10.1186/1757-7241-16-11
Source: PubMed


In the early minutes of cardiac arrest, timing of defibrillation and cardiopulmonary resuscitation during the basic life support phase (BLS CPR) is debated. Aims of this study were to provide in-hospital incidence and outcome data, and to investigate the relation between outcome and time from collapse to defibrillation, time to BLS CPR, and CPR quality.
Resuscitation attempts during a 3-year period at St. Olav's University Hospital (960 beds) were prospectively registered. The times between collapse and initiation of BLS CPR, and defibrillation were determined. CPR quality was assessed by the resuscitation team. The relation between these variables and outcome (short term survival and discharge) was explored using non-parametric correlation and logistic regression.
CPR was started in a total of 223 arrests, an incidence of 77 episodes per 1000 beds per year. Return of spontaneous circulation occurred in 40%, and 29 patients (13%) survived to discharge. Median time from collapse to BLS CPR was 1 minute; CPR was judged to be of good quality in half of the episodes. CPR during the first 3 minutes in ventricular fibrillation (VF/VT) was negatively associated with survival, but later proved beneficial. For patients with non-shockable rhythms, we found no association between outcome and time to BLS or CPR quality.
Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality.

Download full-text


Available from: Eirik Skogvoll, Jan 28, 2014
13 Reads
  • Source
    • "CPR and AED use by bystanders are very important in the ‘chain of survival’ for both out-of-hospital and in-hospital cardiac arrests to improve patient survival [1,2]. It was reported that survival to hospital discharge is still about 15% to 20% after in-hospital-cardiac arrest [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The 2010 Consensus on Science and Treatment Recommendations Statement recommended that short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered an effective alternative to instructor-led basic life support courses. The purpose of this study was to examine the effectiveness of a simplified cardiopulmonary resuscitation (CPR) training program for non-medical staff working at a university hospital. Methods Before and immediately after a 45-min CPR training program consisting of instruction on chest compression and automated external defibrillator (AED) use with a personal training manikin, CPR skills were automatically recorded and evaluated. Participants’ attitudes towards CPR were evaluated by a questionnaire survey. Results From September 2011 through March 2013, 161 participants attended the program. We evaluated chest compression technique in 109 of these participants. The number of chest compressions delivered after the program versus that before was significantly greater (110.8 ± 13.0/min vs 94.2 ± 27.4/min, p < 0.0001), interruption of chest compressions was significantly shorter (0.05 ± 0.34 sec/30 sec vs 0.89 ± 3.52 sec/30 sec, p < 0.05), mean depth of chest compressions was significantly greater (57.6 ± 6.8 mm vs 52.2 ± 9.4 mm, p < 0.0001), and the proportion of incomplete chest compressions of <5 cm among all chest compressions was significantly decreased (8.9 ± 23.2% vs 38.6 ± 42.9%, p < 0.0001). Of the 159 participants who responded to the questionnaire survey after the program, the proportion of participants who answered ‘I can check for a response,’ ‘I can perform chest compressions,’ and ‘I can absolutely or I think I can use an AED’ increased versus that before the program (81.8% vs 19.5%, 77.4% vs 10.1%, 84.3% vs 23.3%, respectively). Conclusions A 45-min simplified CPR training program on chest compression and AED use improved CPR quality and the attitude towards CPR and AED use of non-medical staff of a university hospital.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 05/2014; 22(1):31. DOI:10.1186/1757-7241-22-31 · 2.03 Impact Factor
  • R. Tsui ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Summary form only given. As the push continues to attain smaller devices and increasing circuit density, the use of individual molecules as device and circuit components becomes progressively more attractive. Molecules are highly uniform and inherently nanoscale, which could be very advantageous for the fabrication of ultra-dense, low-power ICs. Furthermore, they can be synthesized with unique chemical, physical and biological properties that could be used to facilitate self-assembly to one another and to specific surfaces, and to form elements that can perform information processing. The "bottom- up" concept of "molecular electronics" represents a paradigm shift, in which the naturally small starting components self-assemble into devices and circuits. This inherent simplicity may offer significant economic advantage over the traditional "top-down" semiconductor-based approach. Thus, research in molecular electronics has generated considerable interest in recent years. While the concept of molecular electronics is not new and a wide variety, of molecules have been considered as candidates, the last few years have witnessed significant research advances. Custom-synthesized molecules have exhibited useful electronic functions such as switching and memory. Carbon nanotubes, with a diameter as small as 1 nm, have shown transistor-like properties. Meanwhile, others have used the molecular recognition properties of DNA to facilitate the self-assembly of nanoscale structures. Some of these advances will be described. However, while these molecules provide unique features, each has its own individual technical challenges too. And interfacing with the micro-/macro-worlds will also be a key issue. So, while molecular electronics hold tremendous promise as an alternate to conventional scaling, much more interdisciplinary research still remain in order to realize its full potential
    Circuits and Systems, 2002. ISCAS 2002. IEEE International Symposium on; 02/2002
  • Source
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 02/2009; 17(1):31. DOI:10.1186/1757-7241-17-31 · 2.03 Impact Factor
Show more