Resuscitation outcomes for adult patients with in-hospital cardiac arrest: are we successful? an audit of resuscitation outcomes for the period January 2015 to December 2017 at Universitas Academic Hospital, Bloemfontein, using the Utstein Model
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Date
2020-12
Authors
Strydom, Catharina Maria
Journal Title
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Publisher
University of the Free State
Abstract
Background: The Utstein Model consensus definitions and template allows for the reliable and reproducible recording of data during cardiopulmonary resuscitation (CPR). Enabling inter-institutional comparison of resuscitation outcomes to ensure comparable standards of care. Objectives: To assess resuscitation outcomes for adult patients with in-hospital cardiac arrest at Universitas Academic Hospital (UAH), Bloemfontein, using the Utstein Model and compare them to similar institutional outcomes in South Africa as well as internationally. Methods: This study is a retrospective audit of resuscitation reports of adult in-patients for the period January 2015 to December 2017. Results: 194 institutional resuscitation reports were collected for adult in-patients for this study period with 189 reports meeting inclusion criteria. 28,0% of patients survived the cardiac arrest event, 32,8% of patients displayed return of spontaneous circulation (ROSC) with a survival to hospital discharge rate of 12,3%. Of the shockable first rhythms, 2,9% were not defibrillated. Median time to defibrillation was 10 minutes (2-38min range), a large deviation from the acceptable norm at comparable institutions. Advanced airway management strategies made no impact on ROSC (p-value 0.77) or survival to hospital discharge (p-value 0.53). Mechanical ventilation was superior to a bag-mask ventilation strategy for ROSC (p-value <0,001) and survival to hospital discharge (p-value 0.0012). Adherence to ACLS protocols for inotropic support was associated with ROSC (p-value < 0.001) and survival to hospital discharge (p-value <0.001). Conclusion: Resuscitation outcomes at UAH are comparable to similar institutions. UAH should focus on improving defibrillation practice. Adherence to ACLS principles of adrenaline administration is paramount in the survival of cardiac arrest.
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Keywords
Dissertation (M.Med (Anaesthesiology))--University of the Free State, 2020, Utstein, Resuscitation reporting template, Resuscitation, Resuscitation outcomes, Inhospital, Resuscitation, Adult resuscitation outcomes, CPR outcomes, South Africa