Semi-Automatic External Defibrillation: Can we Improve the In-Hospital

Chain of Survival?

Jamie Ranse

Registered Nurse

Graduate Diploma in Critical Care Nursing

Chain of Survival

Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.

Chain of Survival

Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.

Semi-Automatic External Defibrillator

• Various products all use the same principles

• 1 – 2 – 3 step process

“audible or visual prompt to

discharge the defibrillator and

deliver a shock when it

recognises a shockable rhythm”

Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.

Semi-Automatic External Defibrillator

Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html

Semi-Automatic External Defibrillator

Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html

Semi-Automatic External Defibrillator

Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html

Pre-Hospital Chain of Survival

• In Australia survival from a pre-hospital cardiac arrest is approximately 10%

• Efforts to strengthen the Chain of Survival

Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.

Pre-Hospital Chain of Survival

Chicago Airports

Caffrey SL, et al., 2002, ‘Public Use of Automated External Defibrillators’, New England Journal of Medicine, vol. 347, no. 16, pp. 1242 – 1247.

Pre-Hospital Chain of Survival

56%67%

Caffrey SL, et al., 2002, ‘Public Use of Automated External Defibrillators’, New England Journal of Medicine, vol. 347, no. 16, pp. 1242 – 1247.

Pre-Hospital Chain of Survival

Melbourne Shrine of Remembrance

Melbourne Cricket Ground

71%

Wassertheil J, et al, 2000, ‘Cardiac Arrest Outcomes at the Melbourne Cricket Ground and Shrine of Remembrance Using a Tired Response Strategy – a Forerunner to Public Access Defibrillation’, Resuscitation, vol. 44, pp. 97 – 104.

In-Hospital Chain of Survival

• In-hospital cardiac arrest survival rate is approximately 10%

In-Hospital Chain of Survival

Medical Emergency Teams (MET)

Objective:• Identify critically ill patients• Recognise deterioration

Cretikos M & Hillman K, 2003, ‘The Medical Emergency Team: Does it Really Make a Difference?’, Internal Medicine Journal, vol. 33, pp. 511 – 514.

In-Hospital Chain of Survival

Medical Emergency Teams (MET)

Objective:• Identify critically ill patients• Recognise deteriorationAim:• Reduce ICU admissions• Reduce respiratory and cardiac arrest

Cretikos M & Hillman K, 2003, ‘The Medical Emergency Team: Does it Really Make a Difference?’, Internal Medicine Journal, vol. 33, pp. 511 – 514.

In-Hospital Chain of Survival

Medical Emergency Teams (MET)

Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, et al., 2004, ‘Prospective Control Trial of Effect of Medical Emergency Team on Postoperative Morbidity and Mortality Rates’, Critical Care Medicine, vol. 32, no. 4, pp. 916 – 921.

• ICU admissions• Patient length of stay• Adverse patient outcomes

In-Hospital Chain of Survival

• ICU admissions• Patient length of stay• Adverse patient outcomes• Coordinated approach

Survival from in-hospital cardiac arrest remains at

approximately 10%Cretikos M & Hillman K, 2003, ‘The Medical Emergency Team: Does it Really Make a Difference?’, Internal Medicine Journal, vol. 33, pp. 511 – 514.

Medical Emergency Teams (MET)

In-Hospital Chain of Survival

First-Responder Semi-Automatic External Defibrillator Programs

In-Hospital Chain of Survival

West London Hospitals, England

• Multidisciplinary Hospitals

• ~ 1200 beds

• Delayed Defibrillation

• Semi-Automatic External Defibrillation

Spearpoint KG, McLean CP & Zideman DA, 2000, ‘Early Defibrillation and the Chain of Survival in ‘in-Hospital’ Adult Cardiac Arrest; Minutes Count’, Resuscitation, vol. 44, pp. 165 – 169.

41%80%

In-Hospital Chain of Survival

Royal Sussex Hospital, England

• 430 Beds general hospital

• 250 Cardiac Arrests per annum

• Manual defibrillation

• Semi-Automatic External Defibrillators

Coady EM, 1999, ‘A Strategy for Nurse Defibrillation in General Wards’, Resuscitation, vol. 42, pp. 183 – 186.

41%55%

In-Hospital Chain of Survival

St Josef Hospital, Germany

• 636 Beds

• 18/27 (67%) initial rhythm shockable

• 16/18 (89%) return of circulation

• 11/18 (61%) discharged from ICU

• 10/18 (56%) discharged home

• 2.6 minutes quicker

Hanefeld C, Lichte C, Mentges-Schroter I, Sirtl C & Mugge A, [in press - 2005], ‘Hospital-Wide First-Responder Automated External Defibrillator Programme: 1 Year Experience’, Resuscitation.

56%

Recommendations

• Implementation of In-Hospital First-Responder Semi-Automatic External Defibrillator Programs

• Research– Compliance and barriers– Australian perspective– Increase current literature

• Education– Basic Life Support– Public Access Defibrillator Programs

Questions?

Semi-Automatic External Defibrillation: Can we Improve the In-Hospital

Chain of Survival?

Jamie Ranse

Registered Nurse

Graduate Diploma in Critical Care Nursing