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PubMed1986

Advanced cardiac life support.

It is important for all physicians to be familiar with the equipment and medications needed for advanced cardiac life support. The most important aspect in advanced life support is the establishment and maintenance of an airway and ventilation of the patient. Office personnel should be trained in Basic Cardiac Life Support, so that the physician can intubate the patient, start an intravenous line, and administer intravenous medications to support the patient. Appropriate drug dosage tables and defibrillation tables are included in this article.

Adult↗
PubMedDate not supplied

Predicting the outcome of unsuccessful prehospital advanced cardiac life support.

OBJECTIVE: To determine if failure to achieve return of spontaneous circulation following prehospital advanced cardiac life support (ACLS) warrants termination of efforts at the scene. DESIGN: Retrospective case series. SETTING: Memphis, Tenn, a city of 610337 people that is served by a fire department-based emergency medical service system. All city ambulances provide ACLS. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: All patients received prehospital ACLS according to the 1986 American Heart Association guidelines. Following prehospital ACLS, all patients were transported to the nearest hospital emergency department whether or not a pulse was restored in the field. MAIN OUTCOME MEASURES: Survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: Over the 39-month study interval, the Memphis Fire Department treated 1068 victims of out-of-hospital cardiac arrest. Three hundred ten of these (29%) had return of spontaneous circulation prior to transport for some period. The remaining 758 patients (71%) never regained a pulse and were transported with ongoing cardiopulmonary resuscitation. Patients who had return of spontaneous circulation prior to transport were more likely to be admitted (69% vs 7.0%) and far more likely to be discharged alive (26.5% vs 0.4%) than patients who failed to respond to prehospital ACLS. Three patients who survived to hospital discharge despite failure to achieve return of spontaneous circulation prior to emergency medical service transport sustained their cardiac arrest after paramedic arrival. All three were discharged with moderate to severe cerebral disability. CONCLUSION: Rapid transport of adults who fail to respond to an adequate trial of prehospital ACLS does not result in meaningful rates of survival. In such cases, on-line emergency medical service physicians should authorize paramedics to cease efforts in the field.

Aged↗
PubMed1985

Can better basic and advanced cardiac life support improve outcome from cardiac arrest?

The effect of basic and advanced cardiac life support (BLS and ACLS) on long-term survival is dependent upon both the response time and the quality of intervention. Retention research using the results of classroom testing as indirect indicators has shown that performance of BLS and ACLS skills is poor. This suggests that BLS and ACLS courses do not teach the knowledge and skills well, the information is too difficult to retain, testing procedures are faulty, and/or the performance standards are unrealistic. To maximize the likelihood of successful resuscitation from cardiac arrest, we propose the following: (a) simplify the BLS procedures; (b) simplify the BLS and ACLS curricula; (c) simplify teaching strategies; (d) simplify testing based on what steps are required to sustain life; (e) define objective criteria for knowledge acquisition and skill performance; (f) base refresher training on diagnosed deficiencies and evaluate innovative ways to improve retention; (g) develop a resuscitation record to provide accurate documentation of patient status, dysrhythmias, therapy, and responses to therapy; (h) develop a process evaluation tool to evaluate individual and group performances during actual resuscitation; and (i) form an international consortium of BLS and ACLS investigators.

Animals↗
PubMed1986

A new evaluation method for instructors of advanced cardiac life support.

This study evaluated the ability of a specific educational program to teach instructors of advanced cardiac life support (ACLS) how to identify errors committed by team leaders of cardiac arrest simulations. The design compared experimental and control groups for differences in identification of critical performance errors, grade assignments and errors specifically emphasized in the educational program. The group receiving the educational program documented more critical performance errors (1.70 vs. 1.10, P = 0.006), made more correct grade assignments (2.35 vs. 2.0, P = 0.026), and identified more errors that were emphasized in the educational program (3.61 vs. 2.25, P = 0.0001) than the control group. The data strongly suggests that the educational program accounted for the observed differences.

Educational Measurement↗
PubMedDate not supplied

Advanced cardiac life support education: a self-directed, scenario-based approach.

BACKGROUND: The American Heart Association adopted new curriculum guidelines for Advanced Cardiac Life Support (ACLS) education. Requirements include the incorporation of case-based learning strategies in the course format. METHOD: A self-directed, scenario-based course format was developed to incorporate principles of adult learning and to meet the newest curriculum guidelines of the American Heart Association. A post-course survey was used to evaluate the participants' perceptions of the course format and its effects on their learning. RESULTS: Twenty-seven participants completed the course. Analysis of the post-course survey responses indicated participants favored the self-directed, scenario-based design and felt the format contributed to their learning. Additionally, this format was more cost-effective than the traditional 2-day course design. CONCLUSION: The use of a self-directed, scenario-based format creates an optimal environment that fosters the complex cognitive and psychomotor skills learning required to perform ACLS. This format meets the expectations of the American Heart Association curriculum guidelines and should be considered a viable and valuable option for providing ACLS education.

Advanced Cardiac Life Support↗
PubMed1986

Benefits of training physicians in advanced cardiac life support.

Unexpected cardiopulmonary arrests occur commonly both in the prehospital setting and in the course of hospital care. Survival after prehospital arrest is improved if bystanders and paramedics are trained in basic and advanced cardiac life support. However, within the hospital, the bystanders are the physicians; it is not known if life support training of these hospital-based physician bystanders leads to improved survival. Therefore, we reviewed the outcome of resuscitation attempts in a teaching hospital during two matching six-month periods, before (period 1) and after (period 2) institution of a mandatory course in Advanced Cardiac Life Support (ACLS) for medical houseofficers. It was concluded that survival after inhospital cardiopulmonary arrest is significantly increased if house officers who staff the Code teams are trained in ACLS.

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PubMed2005

Comparison of two standard-setting methods for advanced cardiac life support training.

BACKGROUND: This study used the Angoff and Hofstee standard-setting methods to derive minimum passing scores for six advanced cardiac life support (ACLS) procedures. METHOD: An expert panel provided item-based (Angoff) and group-based (Hofstee) judgments about six ACLS performance checklists on two occasions separated by ten weeks. Interrater reliabilities and test-retest reliability (stability) of the judgments were calculated. Derived ACLS passing standards are compared to historical ACLS performance data from two groups of ACLS-trained internal medicine residents. RESULTS: Both the Angoff and Hofstee standard-setting methods produced reliable and stable data. Hofstee minimum passing scores (MPSs) were uniformly more stringent than Angoff MPSs. Interpretation of historical ACLS performance data from medical residents shows the MPSs derived in this study would yield higher-than-expected failure rates. CONCLUSION: Systematic standard setting for ACLS procedures is a necessary step toward the creation of mastery learning educational programs.

Advanced Cardiac Life Support↗
PubMed1997

Effect of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital.

STUDY OBJECTIVE: To determine the impact of an Advanced Cardiac Life Support (ACLS) training program on resuscitation and survival in a rural hospital. METHODS: Retrospective review of arrests in a 119-bed rural community hospital before, during, and after organization of an ACLS teaching program. ICU logs, death logs, and code review sheets were used to determine resuscitation efforts and outcomes; these were cross-checked with medical and administrative records. From 1980 through 1984, resuscitation attempts were conducted only in the ICU. By 1985, after the training program was instituted, resuscitation efforts were conducted throughout the hospital. Data are presented on resuscitations in the ICU only and on total hospital resuscitations. To assess effort, resuscitation attempts and successes were compared with total death events (ie, total number of hospital deaths plus total number surviving a resuscitation effort). RESULTS: From 1980 through 1984, before ACLS training was instituted, 42 patients were resuscitated and 15 (36%) survived to discharge. From 1985 through 1987, 113 ICU patients were resuscitated and 29 (26%) survived. From 1988 through 1990, after ACLS protocol and code review procedures were established, 81 ICU patients were resuscitated and 23 (28%) survived. The number of attempted resuscitations throughout the hospital increased from 42 in the early period to 179 in the final period, with 15 (36%) and 52 (29%) survivors, respectively. Rates of ICU or hospital-wide resuscitation success were not significantly different over time (P > .3). There were 893 total death events in the early period and 485 in the final period. The percentage of death events with an intervention rose from 5% to 37% (P < .001), and the percentage reversed by intervention increased from 2% to 11% (P < .001). CONCLUSION: After widespread ACLS training and code team organization, there was a significant increase in resuscitation efforts and reversal of death events despite a slight decline in the percentage of patients surviving resuscitation attempts. An ACLS training program in a rural hospital can contribute to increased overall survival.

Georgia↗
PubMed1988

Advanced cardiac life support: a survey of interprofessional attitudes.

A questionnaire survey was conducted of physicians and nurses who had participated in Advanced Cardiac Life Support (ACLS)-Provider courses during a 5-year period. Both physicians and nurses believed that a conjoint physician-nurse ACLS-Provider course was a good learning experience and an excellent exercise in interprofessional communication. On the basis of these data, we suggest that a conjoint ACLS-Provider course be maintained, rather than establishing different modules for different professions.

Attitude of Health Personnel↗
PubMed1997

Aminophylline as an adjunct to standard advanced cardiac life support in prolonged cardiac arrest.

STUDY HYPOTHESIS: We hypothesized that the addition of aminophylline to Advanced Cardiac Life Support (ACLS) interventions would improve the initial resuscitation success rate in an animal model of prolonged cardiac arrest. METHODS: We used a double-blind, placebo-controlled, randomized-block design with a follow-up open-label uncontrolled phase. We studied 24 female domestic mixed-breed swine (body mass, 20 to 25 kg). After electrical induction of ventricular fibrillation, animals were subjected to 8 minutes of no-flow cardiac arrest followed by 1 minute of mechanical ventilation and closed-chest compressions. Nine minutes after arrest, equal numbers of swine received 6 mg/kg intravenous aminophylline (treatment group) and a saline solution placebo (control group), another minute of basic CPR, and standardized ACLS interventions beginning at 10 minutes. Initial resuscitation efforts were continued for at least 20 minutes. In all animals, if initial efforts failed, 6.0 mg/kg intravenous aminophylline, open label, and 10 minutes of additional resuscitation were administered. The primary outcome variables were return of spontaneous circulation (ROSC) and 1-hour survival. We compared groups with the two-tailed Fisher exact test. RESULTS: ROSC occurred in 4 of 12 animals in the treatment group (33%) and 3 of 12 in the control group (25%) (P=.50). Late administration of aminophylline did not result in ROSC in any animal. Survival to 1 hour was greater in the treatment group (4 of 12, 33%) than in the control group (1 of 12, 8%) (P=.16). CONCLUSION: Addition of aminophylline to standard ACLS interventions did not increase the incidence of ROSC or the 1-hour survival rate in a swine model of prolonged cardiac arrest.

Aminophylline↗
PubMed2006

Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice.

BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.

Adult↗
PubMed2007

Review of effective advanced cardiac life support training using experiential learning.

AIMS AND OBJECTIVES: This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. BACKGROUND: The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required. METHOD: A review of available literature regarding ACLS training has been conducted for this discussion. DATA SOURCES AND SELECTION: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. RESULTS: There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. CONCLUSIONS: The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. RELEVANCE TO CLINICAL PRACTICE: It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes.

Advanced Cardiac Life Support↗
PubMed1996

Developing and revising the American Heart Association guidelines for advanced cardiac life support.

Cardiovascular nurses are active participants in implementing emergency cardiac care (ECC) guidelines as advanced cardiac life support (ACLS) providers and instructors. Cardiovascular nurses should play a key role in the ECC guidelines revision process. The article discusses the process of the most recent ECC guideline developments and revisions and describes subsequent changes to ACLs protocols.

Adult↗
PubMedDate not supplied

Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests.

OBJECTIVE: To determine the retention of Advanced Cardiac Life Support training of internal medicine residents as a function of the time since successfully completing ACLS training. DESIGN: Prospective, consecutive sample of patients who underwent a cardiopulmonary resuscitation effort directed by physicians who successfully completed ACLS. SETTING: Eastern community teaching hospital. PATIENTS: 180 consecutive patients over the age of 18 years who sustained a cardiopulmonary arrest and whose resuscitation efforts were directed by physicians who successfully completed ACLS. Forty-five additional resuscitative efforts hospital wide were led by non-ACLS-trained physicians during the study period. OUTCOME MEASURES: Correctness of the diagnosis of rhythms and treatment of the rhythms diagnosed were assessed, as per ACLS protocols in effect at the time of the study, in 1991. INTERVENTION: None. RESULTS: Chi-squares were used for analysis. Seventy-six of the resuscitative efforts were run by medical residents with a 13.2% error rate. The error rate in the first 6 months after ACLS completion among residents was 5.1%, as compared with 21.6% in the next 6 months (p = 0.033), with no impact on actual survival rate. During the study period, error rates among other groups were 8.8% in Emergency Department physicians and 17.8% among non-ACLS-trained physicians. CONCLUSIONS: The error rate found was lower than in previous studies evaluating retention of ACLS education. It is important to have regular updates in ACLS to ensure proper protocol use.

Adult↗
PubMed1998

Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest? The OTAC Study Group.

STUDY OBJECTIVE: The benefit of Advanced Cardiac Life Support (ACLS) medications during cardiac resuscitation is uncertain. The objective of this study was to determine whether the use of these medications increased resuscitation from in-hospital cardiac arrest. METHODS: A prospective cohort of patients undergoing cardiac arrest in 1 of 5 academic hospitals was studied. Patient and arrest factors related to resuscitation outcome were recorded. We determined the association of the administration of ACLS drugs (epinephrine, atropine, bicarbonate, calcium, lidocaine, and bretylium) with survival at 1 hour after resuscitation. RESULTS: Seven hundred seventy-three patients underwent cardiac resuscitation, with 269 (34. 8%) surviving for 1 hour. Use of epinephrine, atropine, bicarbonate, calcium, and lidocaine was associated with a decreased chance of successful resuscitation (P <.001 for all except lidocaine, P <.01). While controlling for significant patient factors (age, gender, and previous cardiac or respiratory disease) and arrest factors (initial cardiac rhythm, and cause of arrest), multivariate logistic regression demonstrated a significant association between unsuccessful resuscitation and the use of epinephrine (odds ratio . 08 [95% confidence interval .04-.14]), atropine (.24 [.17-.35]), bicarbonate (.31 [.21-.44]), calcium (.32 [.18-.55]), and lidocaine (.48 [.33-.71]). Drug effects did not improve when patients were grouped by their initial cardiac rhythm. Cox proportional hazards models that controlled for significant confounders demonstrated that survivors were significantly less likely to receive epinephrine (P <. 001) or atropine (P <.001) throughout the arrest. CONCLUSION: We found no association between standard ACLS medications and improved resuscitation from in-hospital cardiac arrest. Randomized clinical trials are needed to determine whether other therapies can improve resuscitation from cardiac arrest when compared with the presently used ACLS drugs.

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PubMed1987

Advanced cardiac life support refresher course using standardized objective-based Mega Code testing.

The American Heart Association (AHA) recommends that those whose daily work requires knowledge and skills in advanced cardiac life support (ACLS) not only be trained in ACLS, but also be given a refresher training at least every 2 yr. However, AMA offers no recommended course for retraining; no systematic studies of retraining have been conducted on which to base these recommendations. In this paper we review and present our recommendation for a standardized approach to refresher training. Using the goals and objectives of the ACLS training program as evaluation criteria, we tested with the Mega Code a sample population who had previously been trained in ACLS. The results revealed deficiencies in ACLS knowledge and skills in the areas of assessment, defibrillation, drug therapy, and determining the cause of an abnormal blood gas value. We combined this information with our knowledge of other deficiencies identified during actual resuscitation attempts and other basic life-support and ACLS teaching experiences. We then designed a refresher course which was consistent with the overall goals and objectives of the ACLS training program, but which placed emphasis on the deficiencies identified in the pretesting. We taught our newly designed refresher course in three sessions, which included basic life support, endotracheal intubation, arrhythmia recognition and therapeutic modalities, defibrillation, and Mega Code practice. In a fourth session, using Mega Code testing, we evaluated knowledge and skill learning immediately after training. We similarly tested retention 2 to 4 months later. Performance immediately after refresher training showed improvement in all areas where performance had been weak.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1994

Quality of on-site performance in prehospital advanced cardiac life support (ACLS).

UNLABELLED: The aim of our prospective study was to assess the structural and procedural quality of an urban emergency medical services (EMS) system providing prehospital basic and advanced cardiac life support (BLS/ACLS), to compare the onsite performance of physicians and non-physicians in ECG diagnosis and defibrillation, and to identify incidence and causes of avoidable delays in the initial treatment sequences. METHODS: Between 1 February 1991 and 1 July 1992, 162 on-line tape recordings of prehospital cardiopulmonary resuscitation (CPR) efforts performed by the staff of the EMS system of the city of Mainz were evaluated. After arrival at the patient's side, time intervals to initial ACLS steps (first ECG-diagnosis, first defibrillation, endotracheal intubation, first epinephrine administration) were measured. Times to rhythm identification and countershock by EMT-Ds vs. physicians were compared (Mann-Whitney U-test). Time intervals are presented as median values. One-hundred sixty-two adult patients with out-of-hospital cardiac arrests (ventricular fibrillation [VF] or ventricular tachycardia [VT], 72; asystole or electromechanical dissociation [EMD], 90) receiving CPR by EMTs, EMT-Ds, and physicians of the Mainz EMS were included. Patients with arrests due to non-cardiac aetiologies were excluded. RESULTS: After arrival at the patient's side, for patients with VF/VT, the EMT-Ds took 1:36 min and the physicians took 1:00 min to obtain the first ECG diagnosis (P = 0.004). The first countershock was delivered within 1:42 min by both EMT-Ds and physicians of the mobile intensive care unit (MICU). After diagnosis was established, the EMT-Ds took 0:08 min to defibrillate, whereas the physicians took 0:36 min (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary Resuscitation↗