Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines

Aim: To assess the effectiveness of the ILCOR Advisory Statements on Advanced Life Support adopted by the Resuscitation Council (UK), as the standard for resuscitation following cardiac arrest. Method: Over the period May to November 1997, data on the process and outcome of cardiopulmonary resuscitation following in-hospital cardiac arrest were collected from 49 hospitals throughout the UK. Results: Of 2074 audit forms submitted, 1368 were included in the final analysis. The initial rhythm monitored was ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in 429 patients, of whom 181 (42.2%) were discharged alive, compared to 6.2% when the initial rhythm was non-VF/VT. Overall, 240 (17.6%) patients were discharged alive. At 6 months after discharge 195 (82.3%) of 237 patients were still alive. Successful initial resuscitation, defined as return of spontaneous circulation lasting longer than 20 min (ROSC > 20 min), was significantly associated with VF/VT as the initial arrest rhythm, return of circulation in less than 3 min, age less than 70 years and the use of an advanced airway (P < 0.01). There was a significant increased likelihood of survival to discharge when the circulation was restored in less than 3 min and age was less than 70 years (P < 0.05). The administration of any adrenaline (epinephrine) was significantly associated with a reduced likelihood of ROSC > 20 min or alive discharge (P < 0.0001). Conclusion: Compared to the last major multiple hospital study published in 1992, the results of this study suggest that there appears to have been an improvement in survival of in-hospital patients in the UK who have a VF/VT cardiac arrest. How much of this is directly attributable to the adoption of the latest guidelines is uncertain. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.