Delay In The Administration Of Adrenaline For Cardiac Arrest Increases Mortality

Most causes of cardiac arrests in hospital patients, about 80%, are due to non-shockable rhythms where, despite many complaints by the medical fraternity, are still represented by movies and television shows as being managed by defibrillating (shocking) patients using a defibrillator. The fact is that these conditions are managed by performing high-quality CPR (cardio-pulmonary resuscitation) through chest compressions and ventilation of the patient, and administering medications that stimulate the heart muscle such as adrenaline and atropine. Unfortunately, in general, these non-shockable cardiac arrests have a much lower survival rate than shockable rhythms.

It is known that patients who experience cardiac arrests due to non-shockable rhythms in hospital, and who receive adrenaline beyond 5 minutes after the episode, have a lowered survival rate. What isn't known though is what the extent of the hospital variation is in delayed adrenaline administration and its impact on patient outcomes at hospital level.

The study

Researchers looked at and analyzed nearly 104,000 records of patients, of 18 years and over, who had cardiac arrests (whose hearts had stopped) while in hospital and who received at least one dose of adrenaline. The information was collected from a large national registry overseen by the American Heart Association, and looked at patient information from nearly 550 hospitals across the United States.

The findings

The following discoveries were made when the data was researched.

• There was a large variability in how quickly adrenaline was administered among the different hospitals that were reviewed. The data showed that hospitals that were managing large number of patients with cardiac arrests, were administering adrenaline at a faster rate than those that were treating a relatively lower number of cases.
• Close to 13% of patients survived cardiac arrest when adrenaline was given within the first 5 minutes of the incident, compared to around 11% when adrenaline was given after five minutes. This finding was independent of all other aspects of care, and also quite significant because this meant that there was a 20% better survival rate in the former mentioned patients.
• Delayed adrenaline administration also seemed to result in unfavourable outcomes on the functional recovery of the patient.

READ Sudden Cardiac Arrest and Primary First Aid Treatment

The clinical significance

Further research

The researchers of this study want to further investigate the processes that are used at hospitals with few delays in adrenaline administration, and compare them with the processes of hospitals where there are more frequent delays. This would help to identify patterns that could help improve the time it takes to administer adrenaline and whether doing so would improve the patients' survival rates.

Basic Life Support - Protocols During Choking, Drowning and Cardiac Arrest

Numerous countries around the world have protocols on how to administer basic life support (BLS) and they are devised by the medical associations situated in those countries. Most places though have adopted the BLS protocols of the American Heart Association, and they include algorithms providing emergency management for conditions such as choking, drowning and cardiac arrest. BLS management protocols doesn't include treating affected individuals with invasive measures, such as putting up an intravenous line or intubating, or medications.

Emergency personnel such as ambulance workers, police officers, firefighter and lifeguards are required to be certified in performing BLS skills. Other individuals who need BLS training include security personnel, teachers, social workers and daycare providers. Parents and older children are also encouraged to learn BLS skills, especially when there is a new member of the family.

Performing high-quality CPR has been proven to improve a patient's survival rate, and gives advanced life support (ALS) providers time to arrive and administer this advanced level of care where needed. 

The availability of a device known as an automated external defibrillator (AED) is an integral part of BLS, and it improves the survival rate of patients in cardiac arrest due to shockable heart rhythms.

The aim of BLS is to promote appropriate blood circulation throughout the body with good quality chest compressions, making sure there's a clear airway and provide adequate ventilation for the patient. The principles of BLS is C.A.B. which stands for the following:

Circulation

You need to make sure that an adequate supply of blood transports oxygen and essential nutrients to the vital organs and tissues of the body. This is done by performing good-quality CPR and, in this case, means performing high-quality chest compressions.

Chest compressions should be completed as follows:

• Press hard and press fast at a rate of 100 compressions per minute for all age groups.
• Allow for full chest recoil to occur between each compression. 
• For adults push up to 5 cm, a child up to 4 cm and infants up to 3 cm or 1/3 of the chest diameter deep.
• Keep counting aloud so that you don't lose count.  

Airway

The airway need to be cleared, protected and maintained at all times so that an adequate amount of air can enter the lungs. NEVER perform a finger sweep to remove a foreign object in a person who is choking, as this can cause the object to be pushed further down the airway. Rather try to remove the object by performing the Heimlich maneuver.

READ What You Need To Know About The New CPR

If the patient isn't breathing and the airway is clear, then you need to administer 2 breaths after each 30 chest compressions. This is done by using a face shield to administer breaths mouth-to-mouth, unless the patient is a family member or close friend, or a bag-valve mask (which is only available in very good first aid kits or carried by emergency health personnel). 

Breathing

A clear airway will allow the lungs to fill with oxygen and get rid of carbon dioxide provided they can inflate and deflate adequately. When administering breaths, you should make sure that the chest lifting adequately as this will suggest adequate filling of the lungs. If the chest isn't rising well enough, then you need to make sure that you're getting a good seal around the patient's mouth.

Contact your nearest hospital to find out where courses are being taught if you want to receive BLS training.