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Pulseless Electrical Activity (PEA) and aystole are the most common initial rhythms in patients with in-hospital cardiac arrest. Respiratory failure is the most common cause for Rapid Response Team alert, and may be the initial cause for in-hospital cardiac arrests. Although cardiac monitoring is shown to be ineffective in identifying patients at risk for cardiac arrest, it is the most common monitoring used on the wards. As many of the cardiac arrests may have a respiratory origin, respiratory monitoring could identify patients at risk to develop cardiac arrest. Reclassifying cardiac arrests as primary cardiac and secondary would help in identifying secondary causes, and monitoring that could help in early identification of deterioration.
rates for in-hospital cardiac (IHCA) arrest are low. Early defibrillation is
vital and international guidelines, which requests defibrillation within three minutes. Can dissemination of
automatic external defibrillators (AED) at hospital wards shorten time to
defibrillation compared to standard care, calling for medical emergency team (MET)?
Material & Methods: Forty-eight (48) units at S?dersjukhuset, Sweden, were
included in the study. They were divided into the intervention group (24 units equipped with AEDs) and the standard care group (24 units with no AEDs).
Intervention group staff were trained in CPR to use AEDs
and standard care group staff were trained in just CPR. Data were gathered from patient records, AEDs and the Swedish National Registry of
Cardiopulmonary Resuscitation (NRCR). Results: 126 IHCA patients were included,
47 in the standard care group, 79 in the intervention group. AEDs in the
intervention group were connected to a defibrillator and it was ready to shock
before arrival of MET in 83.5% of
all cases. AEDs were ready
to be used on average 96 seconds (14-427 s) before arrival of MET. Seven
(15%) patients were defibrillated in the control group and Twenty (25%) in the
intervention group. Defibrillation within three minutes occurred in 67% in the
intervention group (11/17), compared with none (0/7) in the control group (p = 0.02). Conclusion: A systematic
implementation of AEDs in hospital wards decrease time to defibrillation
compared to a standard MET response system. Larger studies are needed to
evaluate the impact on the