PREHOSPITAL CARDIAC-ARREST - ROOM FOR IMPROVEMENT

Objective: To audit the outcome from pre-hospital cardiac arrest manag ed by ambulance personnel, and to assess their proficiency by analysin g the time to initiate basic and advanced cardiac life support, the co mpliance with national guidelines, and the overall success of resuscit ation. Design: A retrospective analysis of ambulance service report fo rms of pre-hospital cardiac arrests, where active resuscitation was at tempted by ambulance personnel between October 1992 and May 1993. Sett ing: The City of Salford. Subjects: 100 consecutive patients who suffe red cardiac arrest out-of-hospital and who were brought to the acciden t and emergency department of Hope Hospital alive, or with resuscitati on still in progress. Results: Only 4 of 100 patients were successfull y resuscitated out of hospital, of whom 2 survived to leave hospital. Detailed analysis of pre-hospital performance was performed on 89 pati ents only, as 11 report forms were missing (no successful pre-hospital resuscitations in this 11). Ventricular fibrillation was the first re corded rhythm in 51.7%, but 85.7% were in asystole or electromechanica l dissociation on arrival at hospital. No patient who was still in car diac arrest on arrival at hospital was successfully resuscitated. 11 p atients received 'bystander CPR'. The median time to basic life suppor t was 6 min; the median call-to-response interval was 8 min; the media n call-to-advanced cardiac life support interval was 21 min; the media n on-scene time was 31 min (paramedics), or 15 min (technicians). The dose of drugs given by the intravenous route did not comply with the c ontemporary recommendations in 43.2%, and those doses given by the end otracheal route were inadequate in 37.9% of the cases. Endotracheal in tubation was attempted in all paramedic resuscitations (91.4% success) ; intravenous access was attempted in 60.3% (91.7% success). Conclusio ns: The survival from pre-hospital cardiac arrest in this community is worse than the national average. There is no single explanation for t his. Better community CPR training, greater efficiency at the scene th rough additional personnel, and stricter compliance with national ACLS guidelines, facilitated by extended refresher training, are all requi red if outcome is to be improved.