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Institutional resuscitation protocols: do they affect cardiopulmonary resuscitation outcomes? A 6-year study in a single tertiary-care centre

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Abstract

Purpose

Despite advances in cardiopulmonary resuscitation and widespread life-support trainings, the outcomes of resuscitation are variable. There is a definitive need for organizational inputs to strengthen the resuscitation process. Our hospital authorities introduced certain changes at the organizational level in our in-house resuscitation protocol. We aimed to study the impact of these changes on the outcomes of resuscitation.

Methods

The hospital code blue committee decided to reformulate the resuscitation protocols and reframe the code blue team. Various initiatives were taken in the form of infrastructural changes, procurement of equipment, organising certified training programs, conduct of mock code and simulation drills etc. A prospective and retrospective observational study was made over 6 years: a pre-intervention period, which included all cardiac arrests from January 2007 to December 2009, before the implementation of the program, and a post-intervention period from January 2010 to December 2012, after the implementation of the program. The outcomes of interest were response time, immediate survival, day/night survival and survival to discharge ratio.

Results

2,164 in-hospital cardiac arrests were included in the study, 1,042 during the pre-intervention period and 1,122 during the post-intervention period. The survival percentage increased from 26.7 to 40.8 % (p < 0.05), and the survival to discharge ratio increased from 23.4 to 66.6 % (p < 0.05). Both day- and night-time survival improved (p < 0.05) and response time improved from 4 to 1.5 min.

Conclusions

A strong hospital-based resuscitation policy with well-defined protocols and infrastructure has potential synergistic effect and plays a big role in improving the outcomes of resuscitation.

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Acknowledgments

The authors are indebted to the American Heart Association instructors from MAMC-ITC, New Delhi for teaching us the finer skills of resuscitation and being our mentors. We offer special thanks and acknowledgement to Ms. Namita Bansal, Statistician, SPS Apollo Hospitals, for the data collection and statistical analysis. We also acknowledge the untiring efforts put in by the Quality Assurance department, Ms. Chandneet Bindra, DGM and the Capability Management team, the Code Blue Committee members and the code blue team members who have helped create, run and improve the resuscitation services. This service was introduced as a quality initiative program in the hospital, without any additional outsource funding or staff. The costs for procuring the equipment and setting up the Resuscitation Skill Lab (~50,000 US dollars) and the costs of the certified training programs were borne by the organization (130 US dollars per person).

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Critical Care, SPS Apollo Hospitals, Sherpur Chowk, Ludhiana, 141003, Punjab, India

    Kanwalpreet Sodhi

  2. Department of Anesthesia and Critical Care, SPS Apollo Hospitals, Sherpur Chowk, Ludhiana, 141003, Punjab, India

    Manender Kumar Singla & Anupam Shrivastava

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  1. Kanwalpreet Sodhi
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  2. Manender Kumar Singla
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Correspondence to Kanwalpreet Sodhi.

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Sodhi, K., Singla, M.K. & Shrivastava, A. Institutional resuscitation protocols: do they affect cardiopulmonary resuscitation outcomes? A 6-year study in a single tertiary-care centre. J Anesth 29, 87–95 (2015). https://doi.org/10.1007/s00540-014-1873-z

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  • DOI: https://doi.org/10.1007/s00540-014-1873-z

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