The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

IMPLEMENTATION OF THE 2005 AHA CPR GUIDELINES INCLUDING THE USE OF AN IMPEDANCE THRESHOLD DEVICE IMPROVES IN-HOSPITAL CARDIAC ARREST SURVIVAL RATES - A 5-YEAR CASE HISTORY

Ken Thigpen, Laura Simmons, Zinith James, Chad Neely; Pulmonary Services, St. Dominic Hospital, Jackson, MS

BACKGROUND: the 2005 aha guidelines recommended many new interventions/approaches during cardiopulmonary resuscitation (CPR), including a level ii-a recommendation to use the impedance threshold device (ITD). In-hospital cardiac arrests (IHCAs) result in the premature death of >300k patients annually in the U.S. IHCA survival rates average 17% and provide an indicator of in-hospital quality of care. We have tracked outcomes after IHCA since 2006. We implemented the 2005 guidelines with the exception of hypothermia. We focused on high performance CPR (HP-CPR) with use of the ITD. The ITD acts as a mechanical drug by increasing circulation by regulating intra-thoracic pressure. In an effort to improve outcomes from IHCA, we compared our experience over the past 5 years before and after HP-CPR. METHOD: the study was performed at St. Dominic hospital in Jackson, Mississippi. Hospital discharge (HD) rates were compared before and after HP-CPR on a total of 681 patients over 5 years, using fisherÂ’s exact test, odds ratio (or) and 95% confidence intervals (CI). Only the first IHCA occurring on the patients were included. The ratios of survivors to HD to total patients (SHD:TP) based upon patients with a known initial rhythm of ventricular fibrillation/tachycardia (VF/VT), asystole (AS), or pea were also compared before and after HP-CPR. RESULTS: there were 157 IHCAS in the historical control period. From 2006 to 2010, there were 524 patients treated with HP-CPR with at least 1 IHCA. Age, gender, and distribution of presenting rhythms for IHCA remained relatively constant between the 2 groups. HD rates were 28% (145/524) WITH HP-CPR vs 17% (27/157) historically (p=.009, or 1.8, CI [1.2, 2.9]). The % of patients with normal or near-normal cerebral performance category scores (1 or 2) were similar between the two groups: 108/145 (74%) with HP-CPR vs 19/27 (70%) historically. during the control period, the SHD:TP (expressed as %) for patients with VF/VT, as, and pea was 6.8, 7.2, 11.9 with HP-CPR respectively vs 5.1, 5.1, 5.7 historically (p=0.035 for pea) CONCLUSIONS: HP-CPR increased IHCA survival rates by 63% with the largest gain in patients presenting with pea initially. Survival benefit was associated with good neurological outcome and was sustained over four years, which is supportive of widespread adoption of this approach as the standard of care for IHCA. Sponsored Research - None