Successful resuscitation rates more than doubled after the Atlanta VA Medical Center instituted a program of upgrading existing defibrillators and placing automated external defibrillators (AEDs) throughout the hospital, while also educating staff, according to a new study in the Aug. 18, 2004 issue of the Journal of the American College of Cardiology.
“The main, new idea is that our current resuscitation efforts, even in tertiary care hospitals, can be improved by trying new things,” said Samuel C. Dudley Jr., M.D., Ph.D., F.A.C.C., at Emory University School of Medicine and the Atlanta VA Medical Center in Atlanta. “As much as we have come to rely on the ‘code’ system, it has a lot of room for improvement. Secondarily, AEDs work in hospitals, too, not just in places where people may not be as medically sophisticated,” Dr. Dudley said.
Beginning in early 2001, all 68 monophasic defibrillators in the 291-bed hospital were replaced. In high-use areas such as intensive care units, 34 manual biphasic defibrillators that were set to run in automated mode were installed. (A monophasic defibrillator delivers energy in only one direction between the paddles. Biphasic waveforms reverse the electric field during the course of the pulse.) In lower-use areas such as outpatient clinics and chronic care wards, 27 automated external defibrillators (AEDs) were added. These AEDs are similar to the units that are increasingly being placed in public areas. They are designed to be used by people with little or no formal training.
Dozens of workshops, hands-on training sessions, and lectures were held for nurses and physicians at the hospital regarding the role of early defibrillation in CPR (cardiopulmonary resuscitation.)
The researchers, including lead author A. Maziar Zafari, M.D., Ph.D., F.A.C.C., tracked resuscitation statistics before, during and after the defibrillator upgrade program. Between Jan. 1, 1995 and June 30, 2002, there were 569 in-hospital CPR events at the Atlanta VA Medical Center, including 141 events after the start of the program.
The percentage survival of all patients with resuscitation events improved 2.6-fold, from 4.9 percent to 12.8 percent. Looking more closely at the events, the researchers saw that all of the improvement could be attributed to a 14-fold jump in survival to discharge among patients who had no pulse and were experiencing either ventricular tachycardia (VT) or ventricular fibrillation (VF) at the time of CPR.
Dr. Dudley said the results show that hospitals can improve their CPR survival rates.
“I would emphasize that this is a realistic model of a clinical endeavor to improve CPR outcomes in any hospital, by designing a comprehensive program, including intense and continuous educational efforts. Certainly, it is possible to save money on the costs of devices and probably bioengineering support and training by switching many of your current more complicated defibrillators to AEDs. Moreover, the switch is likely to improve patient outcomes. Also, those people still using monophasic devices might consider switching to biphasic devices,” he said.
However, because the program involved more than one type of device, as well as general education about the benefits of rapid CPR, it is hard to be certain which part of the program deserves the most credit for the improvement in survival rates. Also, there may have been other factors that changed around the same time the defibrillator program was instituted.