English summary: CARDIOPULMONARY RESUSCITATION IN A FINNISH TERTIARY REFERRAL HOSPITAL
Background The outcome of in-hospital resuscitation is associated with 1) the cause of sudden cardiac arrest, 2) the time delay to recognition of the condition, 3) the delay to defibrillation and 4) the delay to return of spontaneous circulation (ROSC). Here we analyzed the in-hospital resuscitation practices and success rate at Tampere University Hospital. Identifying potential weaknesses in current practices will enable us to further focus the training of the in-hospital resuscitation team so as to improve patient care.
Methods This was a retrospective, observational study of in-hospital resuscitations in 2005-2008. The reports and the outcome were evaluated using the Utstein template for cardiopulmonary resuscitation (CPR). The information was gathered from the resuscitation forms of each resuscitation event. Any missing information was added from the patient charts.
Results A total of 382 cardiac arrests were recorded during 2005-2008. The incidence of sudden cardiac arrest in the study period was 1.6/1000 hospital admissions. Overall, 202 (53%) of in-hospital cardiac arrest patients achieved ROSC that was maintained (ROSC>20min). A total of 108 (28%) patients survived to hospital discharge, despite the fact that the primary arrhythmia was pulseless electrical activity (PEA). Survival was more likely if the initial rhythm was ventricular tachycardia or pulseless tachycardia or if the total time of resuscitation was shorter than 10 minutes (p<0.001). Patients younger than 80 years of age survived more often than older patients (p<0.05): However, the survival rate of over 80-year-old patients was surprisingly high (n=20; 19%), The time needed for recognition of a lifeless (apnoeic) patient and calling for additional help exceeded the acceptable time recommended in the current guidelines. A large number of patients, up to one third, were not being resuscitated (basic life support) when the resuscitation team arrived. The delay to first defibrillation was almost twice the acceptable delay described in the guidelines. The use of adrenalin was excessive in advanced resuscitations.
Conclusion This investigation revealed an urgent need to improve resuscitation practices and thereby the outcome of cardiac arrest patients on the wards. At the same time survival after a CA at Tampere University Hospital is comparable with the internationally described results. We specifically describe a need to update the logistics, equipment and staff training in our institution. With adequate equipment and appropriately trained staff we can then aim towards the next most important step which is decreasing the unacceptably long time delays in order to improve the in-hospital chain of survival.
