Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests.

OBJECTIVE

To determine the retention of Advanced Cardiac Life Support training of internal medicine residents as a function of the time since successfully completing ACLS training.

DESIGN

Prospective, consecutive sample of patients who underwent a cardiopulmonary resuscitation effort directed by physicians who successfully completed ACLS.

SETTING

Eastern community teaching hospital.

PATIENTS

180 consecutive patients over the age of 18 years who sustained a cardiopulmonary arrest and whose resuscitation efforts were directed by physicians who successfully completed ACLS. Forty-five additional resuscitative efforts hospital wide were led by non-ACLS-trained physicians during the study period.

OUTCOME MEASURES

Correctness of the diagnosis of rhythms and treatment of the rhythms diagnosed were assessed, as per ACLS protocols in effect at the time of the study, in 1991.

INTERVENTION

None.

RESULTS

Chi-squares were used for analysis. Seventy-six of the resuscitative efforts were run by medical residents with a 13.2% error rate. The error rate in the first 6 months after ACLS completion among residents was 5.1%, as compared with 21.6% in the next 6 months (p = 0.033), with no impact on actual survival rate. During the study period, error rates among other groups were 8.8% in Emergency Department physicians and 17.8% among non-ACLS-trained physicians.

CONCLUSIONS

The error rate found was lower than in previous studies evaluating retention of ACLS education. It is important to have regular updates in ACLS to ensure proper protocol use.