title: Monitoring of in-hospital cardiac arrest events with the focus on Automated External Defibrillators--a retrospective observational study.
abstract: BACKGROUND
  Patients with cardiac arrest have lower survival rates, when resuscitation performance is low. In In-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such cases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg University Hospital (Germany) an AED-program was initiated in 2007. Aim of the presented study was to monitor the impact of Automated External Defibrillators on the management of in-hospital cardiac arrest events.
  
  
  METHODS
  The data acquisition was part of a continuous quality improvement process of the Wuerzburg University Hospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no flow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED-activation to the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A questionnaire was completed by the first responders.
  
  
  RESULTS
  From 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AED-application. Complete data were available in 46 cases. The TtC was 34 (32-52) seconds (median and IQR).The TtS was 30 (28-32) seconds (median and IQR). The TtCS was 4 (3-6) seconds (median and IQR). The CCD was 5.5 ± 1 cm while the CCR was 107 ± 11/min. The NFF was calculated as 41 %. ROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred under ongoing CPR to an Intensive Care Unit (ICU).
  
  
  CONCLUSIONS
  The TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be markedly reduced, when the user is trained to interrupt the AED's "chain of advices" by placing the electrode-paddles immediately on the patient's thorax. At this time the AED switches directly to the analysing mode. Intensive training and adaption of the training contents is needed to optimize the handling of the AED in order to maximize its advantages and to minimize its disadvantages.
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany. wurmb_t@ukw.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wurmb
authors.affiliation: Department of Anaesthesiology, Hospital of Ludwigsburg, Posilipoststrasse 4, 71640, Ludwigsburg, Germany. tina.vollmer@kliniken-lb.de.
authors.forename: Tina
authors.initials: T
authors.lastname: Vollmer
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sefrin
authors.affiliation: Emergency Services, Wuerzburg, Germany. martin.kraus@aelrd-bayern.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kraus
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany. happel_o@ukw.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Happel
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany. wunder_c@ukw.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Wunder
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany. steinisch_a@ukw.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Steinisch
authors.affiliation: Department of Anaesthesiology, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany. roewer_r@ukw.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Roewer
authors.affiliation: Department of Internal Medicine II, St. Elisabeth Hospital Straubing GmbH, St. Elisabeth-Strasse 23, 97315, Straubing, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Maier
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D047548:Defibrillators / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007318:Inservice Training; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome