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Cardiac Arrest is when the heart completely stops, and perfusion is absent. What this means is that the flow of blood to vital organs including the brain, lungs, etc. is not happening. The occurrence of cardiac arrest is a worldwide epidemic with various causes, including overdose, old age, trauma, and unhealthy people. The majority of cardiac arrest occur outside the hospital where the public (layperson) performs CPR until paramedics arrive. The teams who respond outside of the hospital are well trained and organized and institute a “pit stop†method of delivering life-saving care. The “pit stop†method of delivering emergency cardiac care is the same concept of the race car drivers who stop to change their tire or receive additional maintenance to their vehicle. In addition, the equipment that is used on patients outside of the hospital is clean and for the most part not sterile. On the other hand, in-hospital resuscitation is not that dissimilar but with, unlike approaches.
Inside the hospital, patients have constant evaluations with check-ups about every five to fifteen minutes. In addition, these patients are being monitored from a nursing station and if vital signs change to unacceptable levels, an alarm will sound, unlike that of being outside the hospital. One major difference is when the patient needs CPR. CPR outside of the hospital may not occur in a good time or be completely absent for an extended period of time. While inside the hospital, CPR is started immediately with the help of a skilled nursing team trained in the art of Advanced Cardiac Life Support (ACLS). Other people who arrive in a very short duration are doctors, anesthesiologist, Pharmacist, nursing technicians, radiology technicians, and laboratory personnel for blood gases and radiological procedures. Clearly, in-hospital cardiac arrest receives the best chance for survival because of the available staff that responds at a moment notice.
Other factors that influence the cardiac arrest patient’s outcome while in the hospital is that the equipment is sterile and there are no extrication issues that are frequently encountered by the paramedics. The chance of infection is still there but significantly decreased. Moreover, the possibility of not having a quick reaction team in the hospital is virtually absent. In fact, when a patient is not in cardiac arrest but is still breathing poorly, most hospitals policy is to respond the quick reaction team to take definitive action to prevent further damage to the heart and improve the patient’s outcome. For the cardiac arrest patients, the “code blue†team is activated and the team effort along with advance knowledge prevails because no interruptions in chest compressions is noted because of the attention to detail.
It should be noted that less interruptions from chest compressions are paramount, and when the patient is being transported or is in a conspicuous position where EMS has to adjust their treatment modality, the interruptions are unavoidable. Thus, the best chance is in the hospital but that is not always the case.
As time progresses, the hope for out of hospital cardiac arrest will improve but will never be the same as in-hospital cardiac arrest treatment. Furthermore, additional study is required to understand the survival rate and mental stability of the patient in cardiac arrest that occurs in and outside of the hospital. However, it is possible that the numbers may not change or make that much of a difference since the situations frequently change where a patient suffers a cardiac arrest. It is also important that hospital staff maintain their readiness to handle a cardiac arrest by continuous training and renewal of cards.
In some hospitals, CPR management is adhered to by the use of in-hospital training that is not connected to the American Heart Association (AHA). The technique is a bit dissimilar, but the outcome may be the same. Nonetheless, the hospitals who have their own training does not accept the training cards from the AHA. In this case, it is advisable to retrieve or maintain a card that has been issued by the AHA in case a change in work locations has to take place.
Those hospitals who administer their own cardiac arrest training are still good and recognized nationally, and both are based on research. The AHA is recognized nationally and internationally and thus is favorable on a job application. Finally, in-hospital CPR is not the same as out-of-hospital CPR. The differences are in immediate availability of team members, clean and sterile equipment and professional services at the bedside, whereas, out-of-hospital CPR does not have these amenities.
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Ennis is an Advance Life Support caregiver providing emergency care, training, motivating and educating on a national level for over 35 years with strong concentration and enormous success in business consultation, motivational and safety speaking, minor project management and customer service management. Ennis has been a Supervisor and Associate Supervisor in California, Okinawa Japan, and S. Korea with experience in leading teams and managing large groups of personnel.
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Cardiac Arrest is when the heart completely stops, and perfusion is absent. What this means is that the flow of blood to vital organs including the brain, lungs, etc. is not happening. The occurrence of cardiac arrest is a worldwide epidemic with various causes, including overdose, old age, trauma, and unhealthy people. The majority of cardiac arrest occur outside the hospital where the public (layperson) performs CPR until paramedics arrive. The teams who respond outside of the hospital are well trained and organized and institute a “pit stop†method of delivering life-saving care. The “pit stop†method of delivering emergency cardiac care is the same concept of the race car drivers who stop to change their tire or receive additional maintenance to their vehicle. In addition, the equipment that is used on patients outside of the hospital is clean and for the most part not sterile. On the other hand, in-hospital resuscitation is not that dissimilar but with, unlike approaches.
Inside the hospital, patients have constant evaluations with check-ups about every five to fifteen minutes. In addition, these patients are being monitored from a nursing station and if vital signs change to unacceptable levels, an alarm will sound, unlike that of being outside the hospital. One major difference is when the patient needs CPR. CPR outside of the hospital may not occur in a good time or be completely absent for an extended period of time. While inside the hospital, CPR is started immediately with the help of a skilled nursing team trained in the art of Advanced Cardiac Life Support (ACLS). Other people who arrive in a very short duration are doctors, anesthesiologist, Pharmacist, nursing technicians, radiology technicians, and laboratory personnel for blood gases and radiological procedures. Clearly, in-hospital cardiac arrest receives the best chance for survival because of the available staff that responds at a moment notice.
Other factors that influence the cardiac arrest patient’s outcome while in the hospital is that the equipment is sterile and there are no extrication issues that are frequently encountered by the paramedics. The chance of infection is still there but significantly decreased. Moreover, the possibility of not having a quick reaction team in the hospital is virtually absent. In fact, when a patient is not in cardiac arrest but is still breathing poorly, most hospitals policy is to respond the quick reaction team to take definitive action to prevent further damage to the heart and improve the patient’s outcome. For the cardiac arrest patients, the “code blue†team is activated and the team effort along with advance knowledge prevails because no interruptions in chest compressions is noted because of the attention to detail.
It should be noted that less interruptions from chest compressions are paramount, and when the patient is being transported or is in a conspicuous position where EMS has to adjust their treatment modality, the interruptions are unavoidable. Thus, the best chance is in the hospital but that is not always the case.
As time progresses, the hope for out of hospital cardiac arrest will improve but will never be the same as in-hospital cardiac arrest treatment. Furthermore, additional study is required to understand the survival rate and mental stability of the patient in cardiac arrest that occurs in and outside of the hospital. However, it is possible that the numbers may not change or make that much of a difference since the situations frequently change where a patient suffers a cardiac arrest. It is also important that hospital staff maintain their readiness to handle a cardiac arrest by continuous training and renewal of cards.
In some hospitals, CPR management is adhered to by the use of in-hospital training that is not connected to the American Heart Association (AHA). The technique is a bit dissimilar, but the outcome may be the same. Nonetheless, the hospitals who have their own training does not accept the training cards from the AHA. In this case, it is advisable to retrieve or maintain a card that has been issued by the AHA in case a change in work locations has to take place.
Those hospitals who administer their own cardiac arrest training are still good and recognized nationally, and both are based on research. The AHA is recognized nationally and internationally and thus is favorable on a job application. Finally, in-hospital CPR is not the same as out-of-hospital CPR. The differences are in immediate availability of team members, clean and sterile equipment and professional services at the bedside, whereas, out-of-hospital CPR does not have these amenities.
Vlad Magdalin
