Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities.

BACKGROUND The association between the interval between collapse and defibrillation and outcome is well described in out of hospital cardiac arrest but not as well in in-hospital cardiac arrest. We report the outcome among patients who suffered an in-hospital cardiac arrest and were found in ventricular fibrillation (VF) with the emphasis on the delay to defibrillation. METHODS AND RESULTS In patients who suffered an in-hospital cardiac arrest at Sahlgrenska University Hospital in Göteborg between 1994 and 2002 there were 1.570 calls for the rescue team of which 71% had suffered a cardiac arrest. Among cardiac arrests 47% took place on monitored wards. The proportion of patients found in VF was 59% on wards with monitoring facilities and 45% on wards without (p<0.0001). Approximately 90% of these patients were defibrillated <or=3 min after collapse on monitored wards compared with 54% on non-monitored wards (p<0.0001). Among all patients, there was a strong relationship between the interval between collapse to the first defibrillation and survival to discharge from hospital (p<0.0001): 66% were discharged alive if defibrillated <or=3 min compared with 20% if defibrillated >12 min. On monitored wards, the survival was 63% if defibrillated <or=3 min compared with 60% if defibrillated >3 min after collapse (NS). The corresponding values for non-monitored wards were 72% and 35%, respectively (p=0.0003). Cerebral function among survivors at discharge appeared to be good among the majority of patients both in monitored and non monitored wards. CONCLUSION If patients with in hospital VF were defibrillated early in both monitored and non monitored wards survival to hospital discharge was high. This highlights the importance of being prepared for the rapid defibrillation on wards without monitoring facilities.

[1]  S M Cobbe,et al.  Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the 'Utstein Style'. , 1993, Resuscitation.

[2]  D. Risucci,et al.  In-hospital cardiopulmonary resuscitation: patient, arrest and resuscitation factors associated with survival. , 1990, Resuscitation.

[3]  D J Roe,et al.  Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. , 2000, The New England journal of medicine.

[4]  B. Folk,et al.  Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. , 1989, The American journal of medicine.

[5]  A. Forster,et al.  Derivation of a clinical decision rule for the discontinuation of in-hospital cardiac arrest resuscitations. , 1999, Archives of internal medicine.

[6]  C. Gwinnutt,et al.  Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. , 2000, Resuscitation.

[7]  J. Ornato,et al.  Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. , 1991, Circulation.

[8]  L. Ekström,et al.  A comparison between patients suffering in‐hospital and out‐of‐hospital cardiac arrest in terms of treatment and outcome , 2000, Journal of internal medicine.

[9]  J. Ornato,et al.  Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. , 2003, Resuscitation.

[10]  J. Herlitz,et al.  Survival after cardiac arrest outside hospital in Sweden. Swedish Cardiac Arrest Registry. , 1998, Resuscitation.

[11]  C. McLean,et al.  Early defibrillation and the chain of survival in 'in-hospital' adult cardiac arrest; minutes count. , 2000, Resuscitation.

[12]  J. Schorling,et al.  Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target. , 1994, Archives of internal medicine.

[13]  P. Finne,et al.  Prevalence of 'do not attempt resuscitation' orders and living wills among patients suffering cardiac arrest in four secondary hospitals. , 2003, Resuscitation.

[14]  M. Kuisma,et al.  The incidence of out-of-hospital ventricular fibrillation in Helsinki, Finland, from 1994 to 1999 , 2001, The Lancet.

[15]  P. Good,et al.  Permutation Tests: A Practical Guide to Resampling Methods for Testing Hypotheses , 1995 .

[16]  D. Roberts,et al.  Early predictors of mortality for hospitalized patients suffering cardiopulmonary arrest. , 1990, Chest.

[17]  S. Gisvold,et al.  In‐hospital cardiopulmonary resuscitation , 1999, Acta anaesthesiologica Scandinavica.

[18]  J. Herlitz,et al.  Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden. , 2000, Resuscitation.

[19]  H. Tunstall-Pedoe,et al.  Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. , 1992, BMJ.

[20]  P. Finne,et al.  Evaluation of the in-hospital Utstein template in cardiopulmonary resuscitation in secondary hospitals. , 2003, Resuscitation.

[21]  J. Herlitz,et al.  Characteristics of patients who die in hospital with no attempt at resuscitation. , 2005, Resuscitation.

[22]  L. Ekström,et al.  Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas. , 2001, Resuscitation.