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44 - In-hospital resuscitation
- from Part IV - Therapy of sudden death
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- By Mary Ann Peberdy, Department of Medicine and Emergency Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA, Johan Herlitz, Division of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden, Michelle Cretikos, Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
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- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 782-791
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- Chapter
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Summary
Introduction
In-hospital resuscitation practices have changed very little despite significant advances in resuscitation science. Unlike pre-hospital providers, hospital personnel have been slow to focus on resuscitation practices and even slower to adopt evolving science and technology to improve outcomes. Consequently, there has been no improvement in survival over time for hospitalized patients suffering a cardiorespiratory arrest, where overall survival remains approximately 18%.
Hospitalized patients have different comorbidities from persons who arrest outside of the hospital. In a large series of cardiorespiratory arrests occurring in hospitalized patients in the United States, many arrest patients had electrocardiographic or oximetry monitoring, an invasive airway, or were receiving an intravenous vasoactive drug prior to their arrest, suggesting that this population has varying degrees of underlying instability. Nevertheless, to stop here and suggest that survival will always be poor because the patients are “sick” and cannot be expected to do well leads to a self-fulfilling prophecy. Although the hospitalized patient population may inherently be more acutely ill, the hospital also has potential resources that far outweigh those in the pre-hospital setting.
Different strategies may be necessary to improve survival in the hospital environment. One of the most significant changes that must occur is within the hospital culture. Attention needs to be focused on the science of resuscitation, and on the process of care delivery. The importance of administrative and organizational support is paramount to achieving success. Traditionally, hospitals focus only on the arrest event itself when planning their resuscitation practices. Little attention is given to prevention or the specific care the patient receives after return of spontaneous circulation (ROSC).
27 - Public access defibrillation
- from Part IV - Therapy of sudden death
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- By Roger D. White, College of Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA, Mick Colquhoun, Resuscitation Council, Tavistock Sq., London, UK, Sian Davies, Department of Health, London, UK, Mary Ann Peberdy, Department of Medicine and Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA, Sergio Timerman, Resuscitation Department, Heart Institute of Sao Paolo, Brazil
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
-
- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 496-505
-
- Chapter
- Export citation
-
Summary
Introduction
The development of automated external defibrillators (AEDs) enabled the potential life-saving benefit of rapid defibrillation to be extended into locations outside traditional boundaries. Defibrillation with these devices could now be provided by minimally medically trained persons such as firefighters and police officers. The survival benefit from AED deployment by such users led to the presumption that even more rapid defibrillation might be provided by placement of AEDs in public settings where large numbers of persons are present, and where defibrillation might be accomplished by even less-trained persons, and possibly even by persons not trained at all in AED use. And thus emerged the initiative known as public access defibrillation, or PAD. In this chapter, experience with PAD is described in several different settings, fortunately with acquisition and reporting of data to permit analysis of outcomes. Experience to date is surely encouraging, yet questions remain. Pell and colleagues have raised such questions pertaining to cost-effectiveness and have recommended expansion of first-responder defibrillation such as by police or firefighters and bystander cardiopulmonary resuscitation as more defensible options to PAD.
In the PAD Trial reported by Peberdy in this chapter the low number of events is disheartening in light of the magnitude of the commitment in terms of numbers of persons trained and devices deployed, and the multiple locations in which AEDs were deployed. This observation may reflect yet another reality: the incidence of ventricular fibrillation (VF) as the presenting rhythm in out-of-hospital arrest settings is declining at an impressive rate, as reported now by several cardiac arrest investigators.