Evaluation of a hospital-wide resuscitation team: does it increase survival for in-hospital cardiopulmonary arrest?

Objective: To assess the impact (defined not only with regard to patient ou tcome but also to record keeping for evaluation of care) of a formal, struc tured resuscitation team for in-hospital cardiopulmonary resuscitation over the year following its creation. Methods: This is a "before and after" stu dy in which charts of all patients needing resuscitation during the two-yea r period were reviewed and data arranged in the Utstein Style of in-hospita l reporting of cardiac arrests. The review was limited to adults ( greater than or equal to 18 years of age) in nonICU settings. Results: A total of 2 20 events were identified. Demographics and presenting rhythms for the two periods under review were similar. For the period of August 1996-August 199 7 (group 1). there were 70 resuscitation events recorded with a return of s pontaneous circulation (ROSC) rate of 21/70 (30%:). For the period of Augus t 1997-August 1998 (group 2), 150 events were recorded and the ROSC rate wa s significantly higher 87/150 (58%)) (P = 0.0002). ROSC after ventricular f ibrillation acid ventricular tachycardia was similar in both groups (50 vs 57%) (P = 1.00) but an improvement in survival was seen in group 2 from eve nts of bradycardia/perfusing rhythm (25% vs 84%) (P = 0.0003). Survival fro m PEA/Asystole was also improved during period 2 (18 vs 48%) (P = 0.013). S urvival to discharge was seen in 3/50 (6%) of patients in period 1 and 18/1 02 (18%) of patients in period 2 (P = 0.09). Conclusions: The formation of a structured, formalized hospital resuscitation team was associated with an increase in the number of recorded events, in the number of patients exper iencing ROSC and in the percentage of patients who were discharged from the hospital. Facilities with no formal resuscitation team or with no skilled, practiced resuscitator on their current tram should consider implementatio n of a similar strategy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.