Guidelines for appropriate in-hospital emergency team time management: the Brooke Army Medical Center approach.
Successful outcome following cardiac arrest have been reported in the range of 13-59%. It is well established that the time from the onset of a ventricular arrhythmia to successful defibrillation predicts outcome. Recent out of hospital arrest protocols minimizing time to defibrillation have reported significant improvement in outcomes. The Bethesda conference and American Heart Association (AHA) both set standards for defibrillation time for in hospital codes but do not set standards for other interventions. In February 2000, the Brooke Army Medical Center (BAMC) cardiopulmonary resuscitation committee published time guidelines for the initiation of CPR, emergency team arrival, first defibrillation and first medication. We sought to evaluate resuscitation outcomes before and after this intervention.


METHODS
Data on each response time was prospectively collected as was etiology for the event, emergency location, patient age, gender, and emergency outcome for the 7 months prior to the guideline introduction and 15 months afterwards.


RESULTS
The mean response times (in minutes) for initiation of CPR (1.3 vs. 0.4), emergency team arrival (1.6 vs. 1.2), first defibrillation (7.8 vs. 6.6) and first medication (4.1 vs. 3.8) demonstrated trends toward improvement. Compliance with the time standards also increased (67-91, 85-95, 67-71 and 93-86%, respectively). Emergency survival trended toward improvement (47 vs. 57%) while discharge survival significantly increased from 3 to 24% (P=0.017).


CONCLUSIONS
Setting time guidelines for Advanced Cardiac Life Support (ACLS) improved initiation of CPR, emergency team arrival, first defibrillation, and first medication administration. These time reductions were accompanied by improved event survival and a statistically improved survival to discharge.
Kinney
Kurt G
KG
Cardiology Service, William Beaumont Army Medical Center, WBAMC MCHM MED C, 5005 N Piedras Street, El Paso, TX 79920-5001, USA. kurt.kinney@amedd.army.mil
Boyd
Sheri Y N
SY
Simpson
Daniel E
DE
D022561:Advanced Cardiac Life Support; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy; D006772:Hospitals, Military; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015996:Survival Rate; D013781:Texas; D017748:Time Management; D016896:Treatment Outcome