Effect of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital.
OBJECTIVE
To determine the impact of an Advanced Cardiac Life Support (ACLS) training program on resuscitation and survival in a rural hospital.


METHODS
Retrospective review of arrests in a 119-bed rural community hospital before, during, and after organization of an ACLS teaching program. ICU logs, death logs, and code review sheets were used to determine resuscitation efforts and outcomes; these were cross-checked with medical and administrative records. From 1980 through 1984, resuscitation attempts were conducted only in the ICU. By 1985, after the training program was instituted, resuscitation efforts were conducted throughout the hospital. Data are presented on resuscitations in the ICU only and on total hospital resuscitations. To assess effort, resuscitation attempts and successes were compared with total death events (ie, total number of hospital deaths plus total number surviving a resuscitation effort).


RESULTS
From 1980 through 1984, before ACLS training was instituted, 42 patients were resuscitated and 15 (36%) survived to discharge. From 1985 through 1987, 113 ICU patients were resuscitated and 29 (26%) survived. From 1988 through 1990, after ACLS protocol and code review procedures were established, 81 ICU patients were resuscitated and 23 (28%) survived. The number of attempted resuscitations throughout the hospital increased from 42 in the early period to 179 in the final period, with 15 (36%) and 52 (29%) survivors, respectively. Rates of ICU or hospital-wide resuscitation success were not significantly different over time (P > .3). There were 893 total death events in the early period and 485 in the final period. The percentage of death events with an intervention rose from 5% to 37% (P < .001), and the percentage reversed by intervention increased from 2% to 11% (P < .001).


CONCLUSIONS
After widespread ACLS training and code team organization, there was a significant increase in resuscitation efforts and reversal of death events despite a slight decline in the percentage of patients surviving resuscitation attempts. An ACLS training program in a rural hospital can contribute to increased overall survival.
Camp
B N
BN
Department of Emergency Medicine, Albany Medical Center, NY, USA.
Parish
D C
DC
Andrews
R H
RH
D005845:Georgia; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006780:Hospitals, Rural; D006801:Humans; D007318:Inservice Training; D008020:Life Support Care / Q000592:standards*; D010564:Personnel, Hospital / Q000193:education*; D012151:Resuscitation / Q000193:education*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome