Adherence to CPR guidelines during perioperative cardiac arrest in a developing country.
BACKGROUND AND GOAL OF STUDY: Cardiopulmonary resuscitation (CPR) is an integral part of anaesthetic training. In Nigeria, these skills are taught mainly during medical school and postgraduate training. International guidelines were introduced in 2000 and new guidelines were produced in November 2005. The study sought to assess how closely anaesthetists in a Nigerian teaching hospital abide by the 2000 guidelines.


METHODS
All perioperative cardiac arrests in adults that occurred in a 1-year-period were studied prospectively. All patients <15 years and cardiac arrests occurring outside the direct supervision of the anaesthetists were excluded. Time and duration of arrest, cardiac arrest rhythm and management were documented along with immediate outcome.


RESULTS
Thirteen cardiac arrests occurred in 2147 perioperative cases (incidence: 6/1000). Seven patients had non ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) rhythms. The mean age of patients was 30.23+/-11.06 years. Orotracheal intubation, manual ventilation with 100% O(2) and external chest compressions were instituted in all cases. The mean duration of arrest was 25.66+/-13.34 min. All patients received adrenaline (epinephrine) and atropine. The median interval between adrenaline doses was 7.5 min. Only one cycle of defibrillation was given to patients in VF/VT. Immediate survival occurred in five patients (38.46%).


CONCLUSIONS
Anaesthetists in our hospital are not applying proper resuscitation guidelines. The lack of organised simulation practice resulted in deficient knowledge and skills. There is a need for continuing training in basic and advanced resuscitation for all anaesthetists according to the guidelines.
Desalu
Ibironke
I
Department of Anaesthesia, College of Medicine, University of Lagos, P.M.B. 12003, Lagos, Nigeria. ronkedesalu@yahoo.com
Kushimo
Olusola
O
Akinlaja
Olufunke
O
D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D019983:Guideline Adherence; D006323:Heart Arrest / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D009549:Nigeria; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors
D000322:Adrenergic Agonists; D000889:Anti-Arrhythmia Agents; D001285:Atropine; D004837:Epinephrine