An audit of drug usage for in-hospital cardiopulmonary resuscitation

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Abstract
The objective of this study was to assess the changes in outcome of cardiac arrest due to ventricular fibrillation, asystole and electromechanical dissociation in relation to the changing guidelines for drug therapy set by the U.K. Resuscitation Council. It was a retrospective study of 667 resuscitation records for the years 1982, 1986, 1988, 1989, 1990 and 1991. It took place in a large district general hospital with a regional cardio-thoracic centre. We have audited the asystolic cardiac arrests (N=271) which occurred outside the cardiac care unit (CCU). Adrenaline (intravenous 1 mg) is now the first line drug followed by atropine at an increased dose (2 mg intravenously); calcium is no longer recommended and sodium bicarbonate should be reserved for cases in which an acidosis has been documented. Atropine use has increased over the 9-year period. Bicarbonate use did not change from 1982 to 1986 but fell progressively to no use at all in 1991. Calcium use has declined since 1982. Adrenaline use has remained unchanged. Survival from asystolic arrests (hospital discharge) has remained unchanged at 0–5·5%. Asystole as a primary event in the CCU was uncommon f N=17) and no patient was discharged. Over the same period, 60% of patients (N=92) with a cardiac arrest on CCU due to ventricular fibrillation (VF) were discharged and 55% were alive after 6 months. For VFon the wards (N=192), only 20% of patients were discharged from hospital. A similar proportion was successful for each year. All cases of electromechanical dissociation on the wards (N=93) and on CCU (N = 19) failed to survive to hospital discharge. Although the U.K. Resuscitation Council guidelines for the management of cardiac arrest are becoming assimilated by the resuscitation teams, changing drug usage has not been associated with an obvious improvement in outcome. The small numbers in this single centre study may have precluded the demonstration of a real benefit of a change in drug usage.

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