The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

IMPLEMENTATION OF THE 2005 CARDIOPULMONARY RESUSCITATION GUIDELINES AND USE OF AN IMPEDANCE THRESHOLD DEVICE IMPROVE SURVIVAL FROM INHOSPITAL CARDIAC ARREST

Ken Thigpen1, Laura Simmons1



Background: The 2005 American Heart Association guidelines recommended many new interventions during cardiopulmonary resuscitation (CPR), including a Level IIa recommendation for an impedance threshold device (ITD), which is intended to further optimize circulation during CPR. Until April, 2008, all data published supporting use of an ITD have been following prehospital cardiac arrest. The objective of this study was to determine the effect that implementing new CPR guidelines, which include use of an ITD, would have on survival to hospital discharge following inhospital cardiac arrest.

Methods: Quality assurance data from adult patients (>18 years) experiencing an inhospital cardiac arrest at a 571-bed, acute care hospital were analyzed. Survival rates from a historical (control) period (01/2006-09/2006) were compared to matched patients in a prospective period (10/06-08/2007) during which the new CPR guidelines and use of an ITD (ResQPOD, Advanced Circulatory Systems; Minneapolis, Minnesota) were implemented. Per hospital protocol, the ITD was used in patients regardless of cardiac arrest etiology, unless specifically overridden by physician.

Results: In both study populations, patients, on average, were 67 years and 49% were male. In the historical (control) group, a Return of Spontaneous Circulation (ROSC) was observed in 52/157 patients (33.1%). For those subjects in the prospective grouping, ROSC was observed in 79/136 patients (58.1%). In the historical (control) group, Survival to Discharge was observed in 27/157 patients (17.2%) versus 38/136 patients (27.9%) in the prospective grouping.

Conclusion: Adoption of the new CPR guidelines and an ITD resulted in a 75% increase in initial arrest survival rates and a 62% increase in survival to hospital discharge rates. This data demonstrates the benefit/impact of new CPR plus an ITD following inhospital cardiac arrest and represents a currently optimized sequence of therapeutic interventions and support widespread adoption of these therapies. (Note: These data were published in a similar format in the April, 2008 issue of Annals of Emergency Medicine)