PHYSICIAN COMPLIANCE WITH ADVANCED CARDIAC LIFE-SUPPORT GUIDELINES

Study objective: To determine compliance with advanced cardiac life su pport (ACLS) guidelines among ACLS-certified and non-ACLS-certified ph ysicians. Design: Retrospective review of consecutive cardiac arrests between July 1989 and June 1990, including assessment of the resuscita tion leaders' ACLS certification. Setting and participants: All nontra umatic prehospital and hospital cardiac arrests in a rural university hospital. Results: Two hundred seven arrests were studied for a total of 436 rhythms with a maximum of 4 rhythms per arrest. There were 78 r esuscitations (36.3%) with return of spontaneous circulation. A total of 2,038 interventions were recorded for all rhythms, with 1,320 (64.8 %) compliant with ACLS guidelines compared with 718 (35.2%) deviations . Synchronized cardioversion, calcium chloride and sodium bicarbonate were used with significantly higher noncompliance. Ventricular fibrill ation had significantly higher mean rhythm deviation scores, whereas s cores were significantly lower for sinus rhythm and stable bradycardia (P<.003). Resuscitations led by ACLS-certified and non-ACLS-certified physicians were compared for mean number of deviations per resuscitat ion attempt, and no differences were found. Resuscitations with return of spontaneous circulation were compared with unsuccessful resuscitat ions, and there was no differences between groups in controlled deviat ion scores. No differences could be found between ACLS-certified and n on-ACLS-certified physicians for return of spontaneous circulation and survival-to-discharge rates. Conclusion: Despite biannual ACLS traini ng of all medical residents and ICU nurses, noncompliance with ACLS gu idelines was noted in 35.2% of treatments. We found no correlation bet ween ACLS certification and ACLS guideline compliance.