Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team.
OBJECTIVE
To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients.


METHODS
This is a "three-phase" (organized, transitional, and re-organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re-organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age).


RESULTS
The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase ( P=0.013 ). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re-organized teams ( P=0.007 ). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods ( P=0.406 ). The chance of survival-to-discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re-organized period ( P=0.496 ). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35-4.80) and witness at the scene (odds ratio: 2.45, 95% confidence interval: 1.34-4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis.


CONCLUSIONS
The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients.
Weng
Te-I
TI
Department of Emergency Medicine, National Taiwan University Hospital, and National Taiwan University Medical College, No. 7 Chung-Shan South Road, Taipei, Taiwan, ROC.
Huang
Chien-Hua
CH
Ma
Matthew Huei-Ming
MH
Chang
Wei-Tien
WT
Liu
Shi-Chi
SC
Wang
Tzung-Dau
TD
Chen
Wen-Jone
WJ
D000552:Ambulances; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002319:Cardiovascular System; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006334:Heart Function Tests; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome