Improving the Rate of Return of Spontaneous Circulation for out-of- Hospital Cardiac Arrests with a Formal, Structured Emergency Resuscitation Team

Objective: To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out- of-hospital cardiac arrest ( OHCA) patients. Methods: This is a "three-phase" (organized, transitional, and re- organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re- organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age). Results: The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase (P = 0.013). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re- organized teams (P = 0.007). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods (P = 0.406). The chance of survival-to -discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re- organized period (P = 0.496). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35-4.80) and witness at the scene ( odds ratio: 2.45, 95% confidence interval: 1.34-4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis. Conclusion: The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients. (C) 2003 Elsevier Ireland Ltd. All rights reserved