1. Pharmacist Impact on Patient Mortality and Advanced Cardiac Life Support Guideline Compliance During In-Hospital Cardiac Arrest
Joseph Cavanaugh, PharmD
PGY1 Resident
Community Medical Center, Toms River, NJ

2. Background The advanced cardiac life support (ACLS) guidelines
Authored by American Heart Association (AHA)
Provide specific algorithms for the treatment of cardiac arrest1
In-hospital cardiac arrests (IHCA)2
1.6 arrests per 1000 admissions
18.4% survival rate

3. Background
Pharmacists have been integrated into response teams in hospitals throughout the United States3
Offer a different perspective
Optimize drug dosing, selection, timing, and administration
Physician compliance with ACLS guidelines is less than 65%4

4. Purpose Primary Objective Secondary Objective
To evaluate the impact of pharmacist participation during IHCA on patient mortality
Secondary Objective
Determine impact of pharmacist participation on ACLS guideline compliance
Identify the total number of guideline deviations

5. Methods Approved by Institutional Review Board
Retrospective chart review
September 1, 2013 to February 29, 2016
Inclusion Criteria
In-hospital cardiac arrest
> 18 years old
Exclusion Criteria
Cardiac arrests in progress upon arrival
Incomplete code sheet documentation
No medications administered

6. Methods Mortality Compliance Statistics At the end of cardiac arrest
Correct medication
Correct dose
Correct timing of doses
Statistics
Continuous Data: Student’s t-test
Nominal: Fisher’s exact test

7. Data Collection
All data was recorded without identifiers and kept confidential
Data was collected from cardiac arrest code sheets and the electronic medical record (EMR)
Patient demographics
Location of cardiac arrest
Length of cardiac arrest
Health professionals present
Presenting rhythm/cause of arrest
Medication doses and timing

8. Results Table 1. Demographics Pharmacist Participation n = 64
No Pharmacist Participation
n = 493
P-value
Male (%)
41 (64.1%)
290 (58.8%)
0.499
Age (years) ( ± SD)
73 ( ± 15.7)
74 ( ± 13.5)
0.616
Average Length of Code
(minutes) ( ± SD)
18.1 ( ± 13.6)
17.4 ( ± 10.3)
0.698

9. Results Table 1. Demographics Pharmacist Participation n = 64
No Pharmacist Participation
n = 493
P-value
General Medicine Floors (%)
11 (17.2%)
186 (37.7%)
0.001
ICU (%)
17 (26.5%)
218 (44.2%)
0.002
Emergency Department (%)
36 (56.3%)
89 (18.1%)
< 0.001

10. Source of Deviation
No Pharmacist
Pharmacist

11. p = 0.001
p = 0.083
p = 0.445

12. Results Table 2. Results Pharmacist Participation n = 64
No Pharmacist Participation
n = 493
P-value
Patient Mortality (%)
29 (45.3%)
245 (49.7%)
0.595
Compliance (%)
46 (71.9%)
209 (42.4%)
< 0.001
Total Deviations
(per cardiac arrest)
37 (0.58)
476 (0.97)
0.008

13. Discussion Pharmacist participation Limitations Similar mortality
1.7 fold increase in compliance
1.7 fold decrease in deviations
Limitations
Retrospective
Charting errors
Small sample size

14. Conclusion
Pharmacist participation significantly increased compliance with the ACLS guidelines

15. Future Steps Expand ACLS Pharmacist Training Increase Response Rate
Staff/Decentralized Pharmacist
Increase Response Rate
Nursing Education Involvement
Cardiac Arrest Simulations

16. References
Neumar RW, Otto CW, Link MS, et al. Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 suppl 3):S729-S767.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics 2016 update: a report from the American Heart Association. Circulation Jan 26;133(4):e38-e360.
Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2014. Am J Health Syst Pharm. 2015;72(13):
Cline DM, Welch KJ, Cline LS, Brown CK. Physician Compliance With Advanced Cardiac Life Support Guidelines. Ann Emerg Med. 1995;25(1):52-57.

17. Assessment Question?
What is the role of a pharmacist during in-hospital cardiac arrest?
Calculate medication dosages
Manage medication preparation
Provide drug information expertise
All of the above

18. QUESTIONS? Joseph Cavanaugh, PharmD PGY1 Resident
Community Medical Center, Toms River, NJ