Innovative Use of AEDs by Nurses and Respiratory Therapists During In-Hospital Cardiac Arrest
Emergency and Critical Care
The overall goal of this proposal is to save the lives of more cardiac arrest victims. We will do this by allowing nurses and respiratory therapists to use AEDs during in-hospital cardiac arrest. This should result in more patients with an initial rhythm of VF/VT. More of these patients will be quickly defibrillated. This should significantly improve survival to hospital discharge. Our leadership role with this innovative program could influence policy making nation-wide. This could save the lives of 1,500 cardiac arrest victims each year in Canada.
We also plan to study the impact of two different teaching strategies. One using conventional nurse educator teaching, the other informed by a survey of nurses and respiratory therapists. We completed this survey using the Theory of Planned Behavior. This will help this study, and future implementation efforts elsewhere.
INTRODUCTION: In-hospital cardiac arrest most commonly occurs in non-monitored areas, where we previously observed a long delay (11 min) before defibrillation (Phase I). We sought to evaluate the benefits of a medical directive allowing RNs and RTs to use AEDs during in-hospital cardiac arrests (Phase II).
METHODS: We performed a health record review examining in-hospital cardiac arrests before (Jan. 2012 – Aug. 2013) and after (Sept. 2013 – March 2014) implementation of The Ottawa Hospital’s AED medical directive. We included in-hospital cardiac arrests for which resuscitation was attempted. We developed a standardized and piloted data collection tool. Trained investigators completed data extraction.
RESULTS: There were 270 in-hospital cardiac arrests for which resuscitation was attempted with the following characteristics (before n=195 vs. after n=75): mean age (68 vs. 69 years), gender distribution (62.1% vs. 64.0% male), witnessed (70.3% vs. 72.0%), initial rhythm PEA (39.0% vs. 27.3%) or VF/VT (26.7% vs. 26.7%), ROSC (65.1% vs. 61.3%), and survival to hospital discharge (24.6% vs. 22.7%). Our primary outcome, mean time to first shock, showed a decreasing trend from 10:54 min in the before group to 8:13 min in the after group (mean difference 2:41 min; p=0.30). An AED was used in four of the 15 VF/VT cases. When an AED was used, the observed time interval between recognition of cardiac arrest and first shock delivery (median 3:30 min) approached the recommended resuscitation guidelines of less than 3 min.
CONCLUSIONS: We successfully implemented a program allowing RNs and RTs to use AEDs during in-hospital cardiac arrests. We anticipate the adoption of such a program in a much larger cohort of hospitals could have a significant impact on survival to hospital discharge for in-hospital cardiac arrest patients.