title: Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines.
abstract: BACKGROUND
  There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based.
  
  
  OBJECTIVE
  The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation.
  
  
  METHODS
  A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes.
  
  
  RESULTS
  The four major findings were: (i) use of fraction of inspired oxygen (FiO2) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission.
  
  
  CONCLUSIONS
  Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required.
authors.affiliation: Northern Health, Epping, 185 Cooper St., Epping, 3076, Victoria, Australia. Electronic address: annabel.milonas@austin.org.au.
authors.forename: Annabel
authors.initials: A
authors.lastname: Milonas
authors.affiliation: Northern Health, Epping, 185 Cooper St., Epping, 3076, Victoria, Australia; Deakin University, School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, Geelong, Australia. Electronic address: a.hutchinson@deakin.edu.au.
authors.forename: Ana
authors.initials: A
authors.lastname: Hutchinson
authors.affiliation: Eastern Health, Nelson Road, Box Hill, 3128, Victoria, Australia. Electronic address: drdavidcharlesworth@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Charlesworth
authors.affiliation: Eastern Health, Nelson Road, Box Hill, 3128, Victoria, Australia. Electronic address: andrea.doric@easternhealth.org.au.
authors.forename: Andrea
authors.initials: A
authors.lastname: Doric
authors.affiliation: Northern Health, Epping, 185 Cooper St., Epping, 3076, Victoria, Australia. Electronic address: john.green@nh.org.au.
authors.forename: John
authors.initials: J
authors.lastname: Green
authors.affiliation: Deakin University, School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, Geelong, Australia; Eastern Health, Nelson Road, Box Hill, 3128, Victoria, Australia. Electronic address: julie.considine@deakin.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
mesh_terms: D000368:Aged; D001315:Australia; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D003422:Critical Care; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Critical care nursing; Emergency nursing; Evidence-based practice; Nursing care; Post resuscitation care