Inventory control for advanced cardiac life support medications.
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Advanced Cardiac Life Support↗
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Advanced cardiac life support becomes basic.
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Advanced Cardiac Life Support↗
Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs.
OBJECTIVE: To generate hypotheses regarding the association of standard Advanced Cardiac Life Support (ACLS) drugs with human cardiac arrest survival. METHODS: This observational cohort study was conducted over a two-year period in the wards, intensive care units, and EDs of two tertiary care hospitals. Included werc adult patients who suffered cardiac arrest either inside or outside the hospital and who required epinephrine according to standard ACLS guidelines. Six standard ACLS drugs (given while CPR was in progress) were assessed for association with survival from resuscitation to one hour and to hospital discharge by univariate and multivariate logistic regression analyses. RESULTS: In the 529 patients studied, initial cardiac rhythm had no impact on the association between drug administration and survival. The time of drug administration (quartile of ACLS period) was associated with resuscitation for atropine (p < 0.05) and lidocaine (p < 0.01). The odds ratios (95% CIs) for successful resuscitation, after multivariate adjustment for potential confounders, were: a respiratory initiating cause, 3.7 (2.1 -6.4); each 5-minute increase in CPR-ACLS interval, 0.5 (0.4-0.7); each 5-minute duration of ACLS. 0.9 (()1.8- 1.0; atropine, 1.2 (1.0-1.3); bretylium. (0.4 (0.1-1.1); calcium 0.8 (0.2-2.4); lidocaine, 0.9 (0.7-1.1); procainamide. 21.0 (5.2-84.0) d sodium bicarbonate 1.2 (1.0-1.6). All other potential confounding variables entered into the model were not significantly associated with resuscitation. CONCLUSION: Initiating cause of arrest, time to ACLS, and duration of ACLS were important correlates of survival. Other than procainaimide, standard ACLS drugs had relatively little association with survival, but timing of administration may be an important factor. Further research using definitive large randomized controlled trials is warranted to assess the role of drug therapy in improving cardiac arrest survival.
Adult↗
Maintaining competency in advanced cardiac life support skills.
One hundred thirty-two physicians who successfully completed advanced cardiac life support (ACLS) training were randomly placed in a control group or one of two groups receiving interventions designed to provide reinforcement of previously mastered knowledge and skills. These interventions included mailed periodic reprints (group 1) or quarterly patient management problems (group 2). All physicians were retested for knowledge and skills related to ACLS one year later. Fifty-two (39.4%) could successfully ventilate the mannequin, and 62 (47.0%) could perform cardiac compression adequately. No differences were noted among groups. Significant differences in knowledge were found. The control group initiated appropriate therapy in a mock-arrest situation 52% of the time, while group 1 averaged 75% and group 2 averaged 82%. These results indicate that reinforcement after continuing medical education may enhance knowledge retention, but does not maintain motor skills. Yearly recertification in ACLS skills should be considered, and frequent practice sessions should be encouraged for those physicians who are not active participants in ACLS activities.
Clinical Competence↗
Cardiopulmonary resuscitation and advanced cardiac life support: common errors and current techniques.
Competence in the techniques of Advanced Cardiac Life Support is essential for physicians who are in frequent contact with patients at high risk for cardiac arrest. The methods utilized are complex and rapidly changing. However, a consistent pattern of errors in fundamental concepts or methods emerges. These can be characterized as (1) errors in the general management of patients, (2) erros in basic cardiopulmonary resuscitation (CPR) techniques, (3) mistakes in the use or omission of appropriate drugs, (4) errors in the associated necessary techniques which require some technical skills, and (5) errors in management of the patient subsequent to the cardiac arrest. Attention to these details may increase success in management of patients with cardiac arrest.
Heart Arrest↗
The ABCs of teaching advanced cardiac life support.
This article describes the evolution in methods used at The Christ Hospital in Cincinnati, Ohio, to teach advanced cardiac life support over the past 10 years. The interactive nature of the teaching methods has improved participants' enjoyment of this course. With smaller teaching groups, instructors find this course challenging and fun to teach. This article provides outlines of teaching stations at The Christ Hospital and examples in which to implement the current advanced cardiac life support content according to the American Heart Association's teaching recommendations.
Heart Arrest↗
The association between age of hospitalized patients and the delivery of advanced cardiac life support.
OBJECTIVE: To determine the extent of variability in the administration of advanced cardiac life support (ACLS) and to determine if age is associated with variability. DESIGN: Retrospective cohort. SETTING: Urban teaching hospital. PATIENTS: One hundred twenty-two adult inpatients without a "do-not resuscitate" order who suffered cardiopulmonary arrest during 1993. MEASUREMENTS AND MAIN RESULTS: Of the total, 35 (29%) survived the arrest and 87 (71%) died. Among the nonsurvivors, two patients received no ACLS and six were not intubated, despite the inclusion of intubation in all ACLS protocols. Of the 87 nonsurvivors, 31 had a single electrocardiographic rhythm during their arrest and should have had similar ACLS trials. However, the 9 nonsurvivors with ventricular fibrillation received a range of 0 to 17 interventions, the 11 with electromechanical dissociation received 1 to 22, and the 11 with asystole received 0 to 14. Based on a protocol-derived definition of a minimal trial of ACLS (a "short ACLS trial") for all 87 nonsurvivors, age greater than 75 was associated with receiving a short trial. Dependent functional status and being on a medical service were also associated with a short ACLS trial. In a logistic regression model including these variables as covariates, age remained significantly associated with a short ACLS trial; odds ratio, 9.71 (95% confidence interval 1.68, 56.1). CONCLUSIONS: Wide variability exists in the administration of ACLS at the studied site. The finding that some patients receive no ACLS suggests that physicians at this site may be making bedside determinations of the likelihood of its benefit based on individual patient characteristics. The association between older age and short ACLS trials among all nonsurvivors suggests that age is most important of these characteristics.
Adult↗
The retention of advanced cardiac life support knowledge among registered nurses.
In an investigation into the retention of advanced cardiac life support (ACLS) knowledge over time, the authors found that ACLS scores significantly decreased for a subgroup of a sample of 40 RNs employed in critical care areas in the first year after certification. Several variables that influenced scores were identified. Recommendations for inservice educators include reconstructing the ways in which ACLS courses are taught, conducting mock mega code scenarios every 6 months, constructing mega code scenarios that reflect the reality of practice, and routinely conducting refresher courses based on problems identified in a particular group.
Adult↗
Advanced cardiac life support for the new millennium.
The American Heart Association has been the recognized source for Advanced Cardiac Life Support (ACLS) education for the past three decades. Since the first ACLS course, numerous revisions have been made to the management algorithms based on evolving scientific evidence. The last revisions made in August 2000 were the first international guidelines published. These guidelines reflect the intense review and analysis of scientific work and emphasize the importance of evidence-based therapies. This article outlines the major changes to ACLS guidelines for dysrhythmias, acute coronary syndromes, and acute stroke management.
Acute Disease↗
Advanced cardiac life support.
It is important for all physicians to be familiar with the equipment and medications needed for advanced cardiac life support. The most important aspect in advanced life support is the establishment and maintenance of an airway and ventilation of the patient. Office personnel should be trained in Basic Cardiac Life Support, so that the physician can intubate the patient, start an intravenous line, and administer intravenous medications to support the patient. Appropriate drug dosage tables and defibrillation tables are included in this article.
Adult↗
Predicting the outcome of unsuccessful prehospital advanced cardiac life support.
OBJECTIVE: To determine if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene. DESIGN: Retrospective case series. SETTING: Memphis, Tenn, a city of 610337 people that is served by a fire department-based emergency medical service system. All city ambulances provide ACLS. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: All patients received prehospital ACLS according to the 1986 American Heart Association guidelines. Following prehospital ACLS, all patients were transported to the nearest hospital emergency department whether or not a pulse was restored in the field. MAIN OUTCOME MEASURES: Survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: Over the 39-month study interval, the Memphis Fire Department treated 1068 victims of out-of-hospital cardiac arrest. Three hundred ten of these (29%) had return of spontaneous circulation prior to transport for some period. The remaining 758 patients (71%) never regained a pulse and were transported with ongoing cardiopulmonary resuscitation. Patients who had return of spontaneous circulation prior to transport were more likely to be admitted (69% vs 7.0%) and far more likely to be discharged alive (26.5% vs 0.4%) than patients who failed to respond to prehospital ACLS. Three patients who survived to hospital discharge despite failure to achieve return of spontaneous circulation prior to emergency medical service transport sustained their cardiac arrest after paramedic arrival. All three were discharged with moderate to severe cerebral disability. CONCLUSION: Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS does not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to cease efforts in the field.
Aged↗
Can better basic and advanced cardiac life support improve outcome from cardiac arrest?
The effect of basic and advanced cardiac life support (BLS and ACLS) on long-term survival is dependent upon both the response time and the quality of intervention. Retention research using the results of classroom testing as indirect indicators has shown that performance of BLS and ACLS skills is poor. This suggests that BLS and ACLS courses do not teach the knowledge and skills well, the information is too difficult to retain, testing procedures are faulty, and/or the performance standards are unrealistic. To maximize the likelihood of successful resuscitation from cardiac arrest, we propose the following: (a) simplify the BLS procedures; (b) simplify the BLS and ACLS curricula; (c) simplify teaching strategies; (d) simplify testing based on what steps are required to sustain life; (e) define objective criteria for knowledge acquisition and skill performance; (f) base refresher training on diagnosed deficiencies and evaluate innovative ways to improve retention; (g) develop a resuscitation record to provide accurate documentation of patient status, dysrhythmias, therapy, and responses to therapy; (h) develop a process evaluation tool to evaluate individual and group performances during actual resuscitation; and (i) form an international consortium of BLS and ACLS investigators.
Animals↗
A new evaluation method for instructors of advanced cardiac life support.
This study evaluated the ability of a specific educational program to teach instructors of advanced cardiac life support (ACLS) how to identify errors committed by team leaders of cardiac arrest simulations. The design compared experimental and control groups for differences in identification of critical performance errors, grade assignments and errors specifically emphasized in the educational program. The group receiving the educational program documented more critical performance errors (1.70 vs. 1.10, P = 0.006), made more correct grade assignments (2.35 vs. 2.0, P = 0.026), and identified more errors that were emphasized in the educational program (3.61 vs. 2.25, P = 0.0001) than the control group. The data strongly suggests that the educational program accounted for the observed differences.
Educational Measurement↗
Advanced cardiac life support education: a self-directed, scenario-based approach.
BACKGROUND: The American Heart Association adopted new curriculum guidelines for Advanced Cardiac Life Support (ACLS) education. Requirements include the incorporation of case-based learning strategies in the course format. METHOD: A self-directed, scenario-based course format was developed to incorporate principles of adult learning and to meet the newest curriculum guidelines of the American Heart Association. A post-course survey was used to evaluate the participants' perceptions of the course format and its effects on their learning. RESULTS: Twenty-seven participants completed the course. Analysis of the post-course survey responses indicated participants favored the self-directed, scenario-based design and felt the format contributed to their learning. Additionally, this format was more cost-effective than the traditional 2-day course design. CONCLUSION: The use of a self-directed, scenario-based format creates an optimal environment that fosters the complex cognitive and psychomotor skills learning required to perform ACLS. This format meets the expectations of the American Heart Association curriculum guidelines and should be considered a viable and valuable option for providing ACLS education.
Advanced Cardiac Life Support↗
Benefits of training physicians in advanced cardiac life support.
Unexpected cardiopulmonary arrests occur commonly both in the prehospital setting and in the course of hospital care. Survival after prehospital arrest is improved if bystanders and paramedics are trained in basic and advanced cardiac life support. However, within the hospital, the bystanders are the physicians; it is not known if life support training of these hospital-based physician bystanders leads to improved survival. Therefore, we reviewed the outcome of resuscitation attempts in a teaching hospital during two matching six-month periods, before (period 1) and after (period 2) institution of a mandatory course in Advanced Cardiac Life Support (ACLS) for medical houseofficers. It was concluded that survival after inhospital cardiopulmonary arrest is significantly increased if house officers who staff the Code teams are trained in ACLS.
Aged↗
Effect of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital.
STUDY OBJECTIVE: To determine the impact of an Advanced Cardiac Life Support (ACLS) training program on resuscitation and survival in a rural hospital. METHODS: Retrospective review of arrests in a 119-bed rural community hospital before, during, and after organization of an ACLS teaching program. ICU logs, death logs, and code review sheets were used to determine resuscitation efforts and outcomes; these were cross-checked with medical and administrative records. From 1980 through 1984, resuscitation attempts were conducted only in the ICU. By 1985, after the training program was instituted, resuscitation efforts were conducted throughout the hospital. Data are presented on resuscitations in the ICU only and on total hospital resuscitations. To assess effort, resuscitation attempts and successes were compared with total death events (ie, total number of hospital deaths plus total number surviving a resuscitation effort). RESULTS: From 1980 through 1984, before ACLS training was instituted, 42 patients were resuscitated and 15 (36%) survived to discharge. From 1985 through 1987, 113 ICU patients were resuscitated and 29 (26%) survived. From 1988 through 1990, after ACLS protocol and code review procedures were established, 81 ICU patients were resuscitated and 23 (28%) survived. The number of attempted resuscitations throughout the hospital increased from 42 in the early period to 179 in the final period, with 15 (36%) and 52 (29%) survivors, respectively. Rates of ICU or hospital-wide resuscitation success were not significantly different over time (P > .3). There were 893 total death events in the early period and 485 in the final period. The percentage of death events with an intervention rose from 5% to 37% (P < .001), and the percentage reversed by intervention increased from 2% to 11% (P < .001). CONCLUSION: After widespread ACLS training and code team organization, there was a significant increase in resuscitation efforts and reversal of death events despite a slight decline in the percentage of patients surviving resuscitation attempts. An ACLS training program in a rural hospital can contribute to increased overall survival.
Georgia↗
Advanced cardiac life support: a survey of interprofessional attitudes.
A questionnaire survey was conducted of physicians and nurses who had participated in Advanced Cardiac Life Support (ACLS)-Provider courses during a 5-year period. Both physicians and nurses believed that a conjoint physician-nurse ACLS-Provider course was a good learning experience and an excellent exercise in interprofessional communication. On the basis of these data, we suggest that a conjoint ACLS-Provider course be maintained, rather than establishing different modules for different professions.
Attitude of Health Personnel↗
Aminophylline as an adjunct to standard advanced cardiac life support in prolonged cardiac arrest.
STUDY HYPOTHESIS: We hypothesized that the addition of aminophylline to Advanced Cardiac Life Support (ACLS) interventions would improve the initial resuscitation success rate in an animal model of prolonged cardiac arrest. METHODS: We used a double-blind, placebo-controlled, randomized-block design with a follow-up open-label uncontrolled phase. We studied 24 female domestic mixed-breed swine (body mass, 20 to 25 kg). After electrical induction of ventricular fibrillation, animals were subjected to 8 minutes of no-flow cardiac arrest followed by 1 minute of mechanical ventilation and closed-chest compressions. Nine minutes after arrest, equal numbers of swine received 6 mg/kg intravenous aminophylline (treatment group) and a saline solution placebo (control group), another minute of basic CPR, and standardized ACLS interventions beginning at 10 minutes. Initial resuscitation efforts were continued for at least 20 minutes. In all animals, if initial efforts failed, 6.0 mg/kg intravenous aminophylline, open label, and 10 minutes of additional resuscitation were administered. The primary outcome variables were return of spontaneous circulation (ROSC) and 1-hour survival. We compared groups with the two-tailed Fisher exact test. RESULTS: ROSC occurred in 4 of 12 animals in the treatment group (33%) and 3 of 12 in the control group (25%) (P=.50). Late administration of aminophylline did not result in ROSC in any animal. Survival to 1 hour was greater in the treatment group (4 of 12, 33%) than in the control group (1 of 12, 8%) (P=.16). CONCLUSION: Addition of aminophylline to standard ACLS interventions did not increase the incidence of ROSC or the 1-hour survival rate in a swine model of prolonged cardiac arrest.
Aminophylline↗