DRUG-THERAPY DURING CARDIAC-ARREST IN 2 HOSPITALS

The results of a study evaluating the appropriateness of drug and defi brillation therapy given during cardiac arrest at two hospitals are re ported. A retrospective study was performed to evaluate and compare th e appropriateness of therapy given during adult cardiac arrest at a la rge teaching hospital (hospital 1) and at a smaller nonteaching hospit al (hospital 2) as measured by conformance to advanced cardiac life su pport (ACLS) guidelines and by less stringent alternative criteria bas ed on published data and clinical judgment. Patients included in the s tudy were older than 18 years and had experienced at least one of five types of cardiac arrest: ventricular fibrillation, asystole, ventricu lar tachycardia, electromechanical dissociation, or bradycardia. The t ype of drug administered, the drug dosage, and the timing of dosages w ere evaluated, as were the timing of defibrillation attempts and the e nergy used for such attempts. Treatment decisions were considered inap propriate if they did not conform to standard (ACLS) or alternative cr iteria. In hospital 1, there were 1137 assessable decisions recorded f or 75 cardiac arrests; of these, 205 (18%) were inappropriate accordin g to standard criteria, and 96 (8.4%) were inappropriate according to alternative criteria. In hospital 2, there were 827 assessable decisio ns recorded for 57 cardiac arrests; of these, 173 (21%) were inappropr iate according to standard criteria, and 98 (11.2%) were inappropriate according to alternative criteria. Inappropriate therapy during cardi ac arrest occurred with a similar frequency in a large teaching hospit al and in a smaller, nonteaching hospital. The number of inappropriate treatments was smaller when more liberal standards of therapy were us ed.