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


METHODS
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.
Spearpoint
K G
KG
Resuscitation Service, Department of Anaesthetics and Intensive Care, Hammersmith Hospital, London, UK.
McLean
C P
CP
Zideman
D A
DA
D001775:Blood Circulation; D004554:Electric Countershock; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008485:Medical Audit; D011446:Prospective Studies; D012151:Resuscitation; D017180:Tachycardia, Ventricular / Q000150:complications; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications