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Contents
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available
at
Resuscitation
j o
u
r n
a l
h o m
e p a g e
:
w w w . e l s e v i e r . c o m / l o c a t e / r e s u s c i t a t i o n
Clinical
Paper
Impact
of
resuscitation
system
errors
on
survival
from
in-hospital
cardiac
arrest
夽
Joseph
P.
Ornato
, Mary
Ann
Peberdy
,
Renee
D.
Reid
,
V.
Ramana
Feeser
,
Harinder
S.
Dhindsa
,
for
the
NRCPR
Investigators
a
Department
of
Emergency
Medicine,
Virginia
Commonwealth
University,
Richmond,
VA,
United
States
b
Department
of
Internal
Medicine
&
Emergency
Medicine,
Virginia
Commonwealth
University,
Richmond,
VA,
United
States
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
14
May
2011
Received
in
revised
form
9
September
2011
Accepted
11
September
2011
Keywords:
Inhospital
Resuscitation
Quality
Outcomes
Errors
a
b
s
t
r
a
c
t
Background:
An
estimated
350,000–750,000
adult,
in-hospital
cardiac
arrest
(IHCA)
events
occur
annually
in
the
United
States.
The
impact
of
resuscitation
system
errors
on
survival
during
IHCA
resuscitation
has
not
been
evaluated.
The
purpose
of
this
paper
was
to
evaluate
the
impact
of
resuscitation
system
errors
on
survival
to
hospital
discharge
after
IHCA.
Methods
and
results:
We
evaluated
subjective
and
objective
errors
in
118,387
consecutive,
adult,
index
IHCA
cases
entered
into
the
Get
with
the
Guidelines
National
Registry
of
Cardiopulmonary
Resuscitation
database
from
January
1,
2000
through
August
26,
2008.
Cox
regression
analysis
was
used
to
determine
the
relationship
between
reported
resuscitation
system
errors
and
other
important
clinical
variables
and
the
hazard
ratio
for
death
prior
to
hospital
discharge.
Of
the
108,636
patients
whose
initial
IHCA
rhythm
was
recorded,
resuscitation
system
errors
were
committed
in
9,894/24,467
(40.4%)
of
those
with
an
ini-
tial
rhythm
of
ventricular
fibrillation
or
pulseless
ventricular
tachycardia
(VF/pVT)
and
in
22,599/84,169
(26.8%)
of
those
with
non-VF/pVT.
The
most
frequent
system
errors
related
to
delay
in
medication
admin-
istration
(>5
min
time
from
event
recognition
to
first
dose
of
a
vasoconstrictor),
defibrillation,
airway
management,
and
chest
compression
performance
errors.
The
presence
of
documented
resuscitation
system
errors
on
an
IHCA
event
was
associated
with
decreased
rates
of
return
of
spontaneous
circu-
lation,
survival
to
24
h,
and
survival
to
hospital
discharge.
The
relative
risk
of
death
prior
to
hospital
discharge
based
on
hazard
ratio
analysis
was
9.9%
(95%
CI
7.8,
12.0)
more
likely
for
patients
whose
ini-
tial
documented
rhythm
was
non-VF/pVT
when
resuscitation
system
errors
were
reported
compared
to
when
no
errors
were
reported.
It
was
34.2%
(95%
CI
29.5,
39.1)
more
likely
for
those
with
VF/pVT.
Conclusions:
The
presence
of
resuscitation
system
errors
that
are
evident
from
review
of
the
resuscitation
record
is
associated
with
decreased
survival
from
IHCA
in
adults.
Hospitals
should
target
the
training
of
first
responders
and
code
team
personnel
to
emphasize
the
importance
of
early
defibrillation,
early
use
of
vasoconstrictor
medication,
and
compliance
with
ACLS
protocols.
© 2011 Elsevier Ireland Ltd. All rights reserved.
1.
Introduction
The
Institutes
of
Medicine
(IOM)
landmark
publication
(“To
Err
is
Human”)
estimated
that
at
least
44,000
and
perhaps
as
many
as
98,000
Americans
die
in
hospitals
each
year
as
a
result
of
med-
ical
the
magnitude
of
the
problem
has
been
夽 A
Spanish
translated
version
of
the
abstract
of
this
article
appears
as
Appendix
in
the
final
online
version
at
doi:10.1016/j.resuscitation.2011.09.009
.
∗ Corresponding
author
at:
Department
of
Emergency
Medicine,
Virginia
Com-
monwealth
University,
1250
East
Marshall
Street
–
Main
Hospital
2nd
Floor,
Suite
500,
Richmond,
VA
23298-0401,
United
States.
Tel.:
+1
804
828
5250;
fax:
+1
804
828
8590.
address:
(J.P.
Ornato).
c
For
the
American
Heart
Association’s
Get
With
the
Guidelines
–
Resuscitation
(National
Registry
of
Cardiopulmonary
Resuscitation)
Investigators,
see
questioned,
Canadian
Adverse
Events
(AE)
Study
confirms
an
alarming
frequency
of
in-hospital
AEs
(7.5
per
100
hospital
admissions;
95%
confidence
interval
[CI],
5.7–9.3),
36.9%
(95%
CI,
32.0–41.8%)
of
which
are
potentially
preventable.
Death
occurred
in
20.8%
(95%
CI,
7.8–33.8%)
of
cases.
The
American
Heart
Association
(AHA)
Get
with
the
Guidelines
National
Registry
of
Cardiopulmonary
Resuscitation
(NRCPR)
col-
lects
data
on
adult
and
pediatric
in-hospital
cardiac
arrest
(IHCA)
events
from
approximately
10%
of
hospitals
in
the
United
From
this
registry,
NRCPR
investigators
have
documented
lower
survival
from
adult
in-hospital
cardiac
arrest
(1)
on
nights
and
weekends
likely
due,
at
least
in
part,
to
system
when
defibrillation
is
delayed
greater
than
2
min
in
patients
whose
ini-
tial
IHCA
rhythm
is
ventricular
fibrillation
or
pulseless
ventricular
tachycardia
(3)
in
certain
hospital
locations.
The
purpose
of
this
paper
was
to
determine
whether
the
presence
of
resuscitation
system
errors
reported
to
NRCPR
are
0300-9572/$
–
see
front
matter ©
2011 Elsevier Ireland Ltd. All rights reserved.
doi:
| Pobierz cały dokument Impact of resuscitation system errors on survival from in hospital cardiac arrest.pdf Rozmiar 447,7 KB |