Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines

Mrs Annabel Milonas1, Professor Julie Considine2,3, Associate Professor Anatascia Hutchinson2, Dr John Green1, Dr David Charlesworth3, Ms Andrea Doric3

1Northern Health, Epping, Australia, 2Deakin University, Geelong, Australia, 3Eastern Health, Box Hill, Australia

Background: There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. It is clear that resuscitation should not stop after return of spontaneous circulation from a cardiac arrest. The Australian Resuscitation Council recommends protocol driven care to enhance chance of survival for cardiac arrest survivors. Emergency healthcare providers’ are obliged to ensure protocol driven post resuscitation care is timely and evidence based.

Objectives: The aim of this study was to examine adherence to best practice guidelines in the first 24 hours post resuscitation in ED and to the ICU having suffered an out of hospital  cardiac arrest and survived initial resuscitation.

Method: A retrospective audit of medical records of survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation & ventilation management, cardiovascular care, neurological care and patient outcomes.

Findings: Four major findings were: i) Use of FIO2 of 1.0 and hyperoxia was common during the first 24 hours of post resuscitation management, ii) Variability in cardiac care, with timely 12 lead ECG and majority of patients achieving systolic BP greater than 100mmHg, but delays in transfer to cardiac catheterization laboratory, iii) Neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients, iv) There was association between in-hospital mortality and specific elements of post-resuscitation care during the first 24 hours of hospital admission.

Conclusion: Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective implementation of research evidence are urgently required.

ACKNOWLEDGEMENTS: This study was funded by a Northern Health Research Grant


Biography:

Annabel is Education Coordinator for the Surgical and Cardiac Clinical Service Unit at Austin Health. Her experience includes an extensive career in emergency nursing education both in the clinical and academic arenas as well as Deterioration and Resuscitation Program Coordinator for Austin Health and Northern Health respectively. Her qualifications include a Masters of Education and is currently studying her second Masters in Terrorism and Security Studies, as well as a specialty in emergency nursing. Her responsibilities include workforce professional development and implementation and development of nursing programs for all level of learners in acute and critical care nursing. She has led organizational implementation of National Health standards  including establishing and maintaining systems for recognizing and responding to deteriorating patients across all sectors of the organization: acute care, sub-acute care and community based care.

A large part of her current role is professional leadership.She is an ARC ALS 2 Director and instructor who travels to other health services and interstate to deliver ALS education. She is currently chair of the Victorian expert group of deterioration and resuscitation coordinators that enables focused expertise and bench-marking in matters of clinical deterioration and resuscitation. She reviews for the Australasian Emergency Nursing Journal.