Response to cardiac arrests in a hospital setting: delays in ventilation.
The outcome following a cardiac arrest is affected by the length of time that elapses before cardiopulmonary resuscitation is initiated. Only 10-15% of patients experiencing cardiac arrest in hospital settings survive to discharge. Therefore, the time between cardiac arrest and administration of cardiopulmonary resuscitation in a metropolitan hospital was examined. All cardiac and respiratory arrests that occurred in the adult non-intensive care areas of a medical center over a period of 16 months were evaluated within 12 h to determine how much time had elapsed before resuscitation was initiated, the devices utilized for initial airway management, and the outcome. To initiate ventilation, bag-valve-masks (BVMs) were used in the majority (76%) of the efforts to resuscitate while mouth-to-mask resuscitation was performed in another 18%; however, in only 37% of the codes was ventilation initiated within 1 min and in 18% ventilation was started after 3 min. Mouth-to-mask resuscitation resulted in more rapid time to onset of ventilation than BVM. In only 18% of the arrests studied was a 'lay-on' mask available in the room and utilized. In 11%, a bag-valve-mask was at the patient's bedside, and in 53% a BVM was taken from the crash cart outside the room. In 63% of the cases where using a lay-on mask was appropriate, it was either not looked for or not present in the patient's room. Also in 37% of the cases where a BVM was needed, one was not readily present because of difficulty in locating the crash cart immediately. Although initiation of cardiopulmonary resuscitation within a minute of a cardiac or respiratory arrest is the standard of care, in the non-intensive care in-patient cases surveyed, typically more than a minute elapsed, and frequently 3 or more minutes, before resuscitation was started. If the time elapsing before an arresting in-patient is ventilated can be shortened, which is easily and effectively achieved by mouth-to-mouth or mouth-to-mask resuscitation, an increase in both the survival rate and the number of good neurological outcomes should be expected.
Brenner
B E
BE
Department of Medicine, Cedars-Sinai Medical Center, UCLA, USA.
Kauffmann
J
J
D000328:Adult; D001049:Apnea / Q000628:therapy; D002140:California / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D004865:Equipment and Supplies, Hospital; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008397:Masks; D009460:Neurologic Examination; D010362:Patients' Rooms; D012121:Respiration, Artificial / Q000295:instrumentation / Q000706:statistics & numerical data*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome