saed: can we improve the in-hospital: chain of survival?
DESCRIPTION
A presentation as a requirement for the Graduate Diploma in Critical Care Nursing - University of Canberra, 2005TRANSCRIPT
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Semi-Automatic External Defibrillation: Can we Improve the In-Hospital
Chain of Survival?
Jamie Ranse
Registered Nurse
Graduate Diploma in Critical Care Nursing
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Chain of Survival
Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.
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Chain of Survival
Australian Resuscitation Council, 1997, ‘Early Defibrillation’, Australian Resuscitation Council Policy Statements Manual, no. 11.7.1, Melbourne, Australia.
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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.
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Semi-Automatic External Defibrillator
Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html
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Semi-Automatic External Defibrillator
Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html
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Semi-Automatic External Defibrillator
Royal Phillips Technology, 2005, http://www.phillips.com.au/index.html
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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.
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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.
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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.
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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.
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In-Hospital Chain of Survival
• In-hospital cardiac arrest survival rate is approximately 10%
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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.
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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.
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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
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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)
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In-Hospital Chain of Survival
First-Responder Semi-Automatic External Defibrillator Programs
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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%
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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%
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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%
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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
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Questions?
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Semi-Automatic External Defibrillation: Can we Improve the In-Hospital
Chain of Survival?
Jamie Ranse
Registered Nurse
Graduate Diploma in Critical Care Nursing