Impact of the Immediate Life Support course on the incidence and outcome of in-hospital cardiac arrest calls: an observational study over 6 years.

BACKGROUND

The Resuscitation Council (UK) Immediate Life Support (ILS) course provides training in the prevention and management of cardiac arrest. This course was introduced at our institution and we subsequently undertook an analysis to determine its impact on the incidence and outcome of in-hospital cardiac arrest.

METHODS

A 6-year prospective audit of 3126 in-hospital emergency alert calls within a multi-site 1200 bedded London teaching hospital following the organisation-wide adoption of the ILS course. Key measures used to detect improvement were the incidence of emergency alert calls, in particular the proportion of calls which were pre-arrest versus cardiac arrest calls, episodes of resuscitations without return of spontaneous circulation, survival to hospital discharge; the proportion of clinical staff who were ILS trained was an important organisational measure.

RESULTS

The total number of emergency alert calls showed no significant change. We observed a reduction in the proportion of calls for cardiac arrests (p<0.0001; from 85% in 2002 to 45% in 2007), a corresponding increase in the proportion of 'pre-arrest' calls (p<0.0001; from 15% in 2002 to 55% in 2007), a reduction in deaths at cardiac arrest (p=0.0002) and an increased survival to hospital discharge following an emergency call from 28% in 2004 to 39% in 2007. There was a temporal relationship between the proportion of staff who were ILS trained and outcome.

CONCLUSION

The introduction of a simple and widespread educational programme was associated with a reduction in both the number of in-hospital cardiac arrests and unsuccessful cardiopulmonary resuscitation attempts.