A questionnaire survey of resuscitation equipment carried by general practitioners and their initial management of ventricular fibrillation.

BACKGROUND

The early defibrillation of patients having a cardiac arrest and who are in ventricular fibrillation has been shown to increase survival and is recommended by the European Resuscitation Council (ERC) and the American Heart Association. General practitioners (GPs) may expect to encounter a cardiac arrest in 5% of patients they attend who have a suspected acute myocardial infarction.

AIM

To establish whether GPs on call were equipped to treat a patient in ventricular fibrillation, and to investigate their knowledge of the early stages of the current ERC guidelines for this cardiac rhythm.

METHOD

A postal questionnaire was sent to all the 175 GPs who regularly admit patients to the West Suffolk Hospital. It asked for details of equipment and drugs carried when on call, recognition of a cardiac rhythm strip of ventricular fibrillation, and treatment to be given for this rhythm.

RESULTS

A total of 105 replies were returned (representing a 60% response rate). The distribution of practice size and location reflected primary health care in this area. Fourteen GPs (13%) had attended an advanced cardiac life-support course at some time, and 44 (41.9%) had read the current ERC guidelines. The majority of GPs (60%) carried advanced airway management equipment to allow endotracheal intubation, but only 37 (35%) would have been able to administer additional oxygen. Again, most (82%) would have been able to establish intravenous access, but only 39% carried 2 mg or more of adrenaline, the only recommended drug in the initial stages of resuscitation from ventricular fibrillation. A defibrillator was carried by 37 GPs (35%) when on call, but out of these only 14 had an integral monitor screen and 3 were semi-automatic defibrillators. Ninety-five GPs (91%) successfully identified ventricular fibrillation, but only 32 (31%) were able to state correctly the initial recommended treatment, and only 17 (16%) were able to quote the first two stages of the ERC guidelines of treatment of ventricular fibrillation. However, 78 GPs (74%) would have provided treatment compatible with the guidelines by giving the patient a pre-cordial thump and two subsequent defibrillatory shocks, albeit perhaps at an incorrect energy level and only if a defibrillator was available.

CONCLUSIONS

This study shows that the equipment carried by the majority of GPs in this area is inadequate to deal successfully with the victims of cardiac arrest, and that significant reliance is placed on the resources of the ambulance service. It would also appear that most GPs are not fully conversant with the current ERC guidelines. The ability of GPs to manage cardiac arrests could be enhanced by their attending courses to update their resuscitation skills, one example being the advanced life-support courses endorsed by the United Kingdom Resuscitation Council, and that the Royal College of General Practitioners could stimulate interest in this area by extending their requirement for candidates for the membership examination to include written documentation demonstrating proficiency at advanced life support, in addition to the current requirement for basic life support only.