Claudio Sandroni a,., Giorgia Ferro a, In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response Claudio Sandroni a,., Giorgia Ferro a, Resuscitation 62(2004) 세브란스병원 응급의학과 1년차 윤우용

Introduction Despite the development of resuscitation, survival in-hospital cardiac arrest remains poor Not much higher than out-of-hospital cardiac arrest In critical care areas, ‘ALS’ is provided by first responders In the wards, only ‘BLS’ is usually possible cardiac arrest team (CAT)

The aims of the present study To assess the characteristics and outcome from cardiac arrests occurring in our hospital To evaluate the factors affecting the outcome

Materials and methods Setting ‘Policlinico Gemelli’ is a 1400-bed tertiary care teaching hospital All cardiac arrests occurring outside the ED are treated by the CAT The CAT is activated using a dedicated telephone number (5555) There are no automated external defibrillators in the wards, The defibrillation is always performed by the CAT.

Patients and data collection 2000.1.1 ~ 2002 1.1 All cardiac arrests which occurred inside the hospital and were treated by the hospital CAT

Data collected Time and date of the arrest Location within the hospital CAT arrival time Patient age and gender Cardiac rhythm and return of spontaneous circulation(ROSC). Status at 20 min and 24 h after the cardiac arrest Functional status at discharge, at 6 months and at 12 months. Causes of cardiac arrest

Results Incidence and general results During the 2 years of study, 91,515 patients were admitted to the hospital During the same period, 2222 patients died Mortality rate of 24.6 per 1000 admissions. A total of 114 patients were included during the study period. (71 male, 43 female, age 65.7±16.7 years, median 71 years)

Discussion The hospital is defined as “self-contained EMS system”. In the hospital the nurses are not allowed to defibrillate They perform only BLS. Defibrillation and ALS depend on the arrival of the cardiac arrest team(CAT).

Elevators !! Wards are distributed on 11 storeys. CAT have to take the elevators, due to emergency cart. The arrival time of the CAT may vary, depending on the ward location and the availability of elevators at the time. As a consequence, a wide range (1–9 min) of call-to-arrival interval.

The time to ALS The time to ALS was a major factor of the prognosis, and was significantly shorter in survivors. In monitored areas ! The delay for ALS is nearly zero, and ALS skills are immediately available. In non-monitored areas, Higher survival rate observed when CAT arrival time was shorter than 3 min.

Higher survival rate in monitored areas Due to much shorter time to ALS Survival rate in ICU was better than in the wards, despite the higher morbidity In the emergency department !! Highest survival rate. Due to a combination of two factors: A very short time of CAT arrival Better pre-arrest morbidity

High survival rate in this study The survival to discharge observed in this study : 32% Higher than that reported in other papers !! 1. the population is selected : DNAR policy 2. all patients received BLS by first responders, 3. 83% of the arrests were witnessed. and average time for ALS was less than 4 min.

Absence of an early defibrillation The major limitation of the emergency response to cardiac arrest in our hospital The survival of VF/VT arrests was not significantly higher than that of non-VF/VT arrests. Dut to delayed defibrillation for the ward patients.

Less than 3 minutes !! In non-monitored areas (in ward), significantly higher survival rates when time to ALS treatment was less than 3 min. Speeding up the arrival of the CAT !!! Priority access to the elevator for CAT

Prevention An extension of the role of the CAT ! The most common causes of cardiac arrest : respiratory insufficiency and hypotension. Medical Emergency Team (MET) !! METs have shown a reduction of the incidence and mortality of in-hospital cardiac arrest . An extension of the role of the CAT ! to early evaluation and stabilization of patient

Conclusions Time to ALS was the most important factor affecting patient survival. This is not surprising, since in non-monitored wards there are NO defibrillators and personnel are NOT ALS-trained !!

Conclusions Both defibrillation and ALS depend on the arrival of the CAT. - by accelerating the CAT arrival and - by providing early defibrillation in the wards. A faster and more efficient response to cardiac arrest can be achieved !!