Mullie A, Van Hoeyweghen R, Quets A
Department of Critical Care Medicine, Algemeen Ziekenhuis Sint Jan, Brugge, Belgium.
Resuscitation. 1989;17 Suppl:S23-33; discussion S199-206. doi: 10.1016/0300-9572(89)90088-9.
Time is an essential element for successful CPR. Two time factors are particularly important: the duration of complete CA and the time to advanced life support. According to a registration protocol, these time factors, together with other variables and outcome were recorded in 3083 CA cases, treated by the NICU teams of 7 major Belgian hospitals. The mean duration of complete CA is 10.3 min for CPR failure (79%); 5.3 min for initial CPR success (21%); 3.4 min for long-term CPCR success (7%). The mean time to ALS is 19.7 min for CPR failure; 14.6 min for initial CPR success: 12.7 min for long-term CPCR success. Both duration of CA and time to ALS are independently related to outcome; the mean duration of BLS is less than 10 min and not significantly related to outcome. Response time of BLS and ALS are increasingly important in their 'rapid response' failure zone (time to ALS more than 8 min, time to BLS more than 4 min). The tiered MICU system, with nurse paramedics before physicians, has equal time to ALS and comparable outcome results to the non-tiered MICU system. According to our present experience, the following time goals are proposed for Belgian EMS-MICU systems: duration of CA less or equal to 4 min (introduction time less than or equal to 1 min and response time of BLS less than or equal to 3 min) and time to ALS less than or equal to 9 min. These time goals stand, in Belgium for perfection of public training in CPR and for spreading of a higher number of MICU teams countrywide.
