Early defibrillation and the chain of survival in ‘in-hospital’ adult cardiac arrest; minutes count

• Published in: Resuscitation 2000-05, Vol.44 (3), p.165-169
• Main Authors: Spearpoint, Kenneth G., McLean, C.Paula, Zideman, David A.
• Format: Article
• Language: English
• Subjects: Automated external defibrillator; Blood Circulation; Chain of survival; Defibrillation; Electric Countershock; Heart Arrest - complications; Heart Arrest - mortality; Heart Arrest - therapy; Hospitalization; Humans; Medical Audit; Outcome; Prospective Studies; Resuscitation; Tachycardia, Ventricular - complications; Time Factors; Utstein template; Ventricular Fibrillation - complications
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/S0300-9572(00)00158-1

Objective: To report the outcomes from and the impact of the chain of survival in ‘in-hospital’ cardiac arrest where the presenting rhythm was VF/VT, the arrest was witnessed, defibrillation was conducted rapidly and no other resuscitation interventions were required. Outcome measures: Any return of spontaneous circulation and discharge from hospital. Methods: A 2-year prospective resuscitation audit using the Utstein style was conducted within a major London NHS Hospital Group. Results: There were 124 patients who had primary VF/VT arrest. Eight were excluded from the study and 14 had non-witnessed cardiac arrest. Twenty one patients had witnessed VF/VT arrest but with delayed defibrillation, 81 patients had witnessed VF/VT arrest with rapid defibrillation, 69 patients had witnessed VF/VT arrest with rapid defibrillation, CPR and other additional interventions. There were 15 patients that had witnessed cardiac arrest with a presenting rhythm of VF/VT, who received rapid defibrillation and had no ventilation or chest compression prior to or following defibrillation. All 15 patients achieved a return of spontaneous circulation, and 12 were discharged alive. Conclusions: Rapid defibrillation prior to any other resuscitation intervention is associated with increased survival from witnessed VF/VT arrest in in-hospital cardiac arrest victims, and that the time to first shock is critical in enhancing the prospects of long-term survival in these patients.