EFFECT OR ADVANCED CARDIAC LIFE-SUPPORT TRAINING ON RESUSCITATION EFFORTS AND SURVIVAL IN A RURAL HOSPITAL

Study objective: To determine the impact of an Advanced Cardiac life S upport (ACLS) training program on resuscitation and survival in a rura l hospital. Methods: Retrospective review of arrests in a 119-bed rura l community hospital before, during, and after organization of an ACLS teaching program. ICU logs, death logs, and code review sheets were u sed to determine resuscitation efforts and outcomes; these were cross- checked with medical and administrative records. From 1980 through 198 4, resuscitation attempts were conducted only in the ICU. By 1985, aft er the training program was instituted, resuscitation efforts were con ducted throughout the hospital. Data are presented on resuscitations i n the ICU only and on total hospital resuscitations. To assess effort, resuscitation attempts and successes were compared with total death e vents tie, total number of hospital deaths plus total number surviving a resuscitation effort). Results: From 1980 through 1984, before ACLS training was instituted, 42 patients were resuscitated and 15 (36%) s urvived to discharge. From 1985 through 1987, 113 ICU patients were re suscitated and 29 (26%) survived. From 1988 through 1990, after ACLS p rotocol and code review procedures were established, 81 ICU patients w ere resuscitated and 23 (28%) survived. The number of attempted resusc itations throughout the hospital increased from 42 in the early period to 179 in the final period, with 15(36%)and 52 (29%) survivors, respe ctively. Rates of ICU or hospitalwide resuscitation success were not s ignificantly different over time (P>.3). There were 893 total death ev ents in the early period and 485 in the final period. The percentage o f death events with an intervention rose from 5% to 37% (P<.001), and the percentage reversed by intervention increased from 2% to 11% (P<.0 01). Conclusion: After widespread ACLS training and code team organiza tion, there was a significant increase in resuscitation efforts and re versal of death events despite a slight decline in the percentage of p atients surviving resuscitation attempts. An ACLS training program in a rural hospital can contribute to increased overall survival.