McEvoy Matthew D, Field Larry C, Moore Haley E, Smalley Jeremy C, Nietert Paul J, Scarbrough Sheila H
Department of Anesthesiology, Vanderbilt University, Nashville, TN 37232, United States.
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
Resuscitation. 2014 Jan;85(1):82-7. doi: 10.1016/j.resuscitation.2013.09.019. Epub 2013 Oct 5.
Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC).
A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC.
In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p<0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p<0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p<0.01 and p<0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs.
Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.
高级心血管生命支持（ACLS）算法是医院内心脏骤停（IHCA）管理的默认标准治疗方法。然而，对已发表指南的遵循情况相对较差。对149例经历过IHCA的患者记录进行检查，以开始了解对ACLS方案的总体遵循情况与自主循环恢复（ROSC）成功之间的关联。
对75例在IHCA事件后实现ROSC的患者（SE组）和74例未在IHCA事件中存活的患者（DNS组）的病历和急救团队工作表进行回顾性图表审查。使用基于2005年ACLS更新方案的详细检查表评估方案遵循情况。还检查了其他几个患者特征和情况作为ROSC的潜在预测因素。
在未经调整的分析中，执行正确步骤的百分比与IHCA后的ROSC呈正相关（p<0.01），而执行错误和遗漏错误的数量均与IHCA后的ROSC呈负相关（p<0.01）。在多变量模型中，即使在考虑了诸如IHCA的年龄和地点差异等混杂因素后，执行正确步骤的百分比以及执行错误和遗漏错误的数量仍然是ROSC的显著预测因素（分别为p<0.01和p<0.0001）。
我们的结果表明，在整个事件中遵循ACLS方案与心脏骤停情况下ROSC增加相关。此外，结果表明，除了正确的操作外，错误操作和指示操作的遗漏都会导致IHCA后ROSC降低。
