Intra-hospital response to cardiac arrest in Rome area

Introduction

The survival from cardiac arrest is strongly influenced by the delay and appropriateness of interventions as CPR and defibrillation. For intra-hospital cardiac arrests which occur in general wards, the ALS rescuers are usually non-readily available at bedside and rescue depends on an emergency team moving inside the hospital. We investigated how the response to cardiorespiratory emergency is organised inside the hospitals in Rome.

Materials and methods

Twenty-five secondary and tertiary level hospitals of the Rome area (2,840,000 inhabitants) have been considered. Among them 22 included an ITU. Data were collected by means of interviews with ALS team members and direct overview on site. The time interval to reach the farthest ward from the starting point of the crash team was also measured.

Results

Only 8% of hospitals have a dedicated telephone number for the emergency team. In 44% of cases a beeper is used, in 40% of cases the personnel call directly the ICU. In the remaining 8% of cases the Anaesthesiologist on duty is called. Only in 27% of cases the beeper allows bi-directional communication. In 42% of cases the number corresponding to the beeper is always the same, while in the remaining cases it may change even daily or from day to night.

The ALS team includes one Anaesthesiologist and one nurse in 20% of cases, one Anaesthesiologist and one optional nurse in 40% of cases and only one Anaesthesiologist in 40% of cases. The ALS equipment carried by the crash team includes a monitor-defibrillator, intubation equipment and drugs in 12% of cases, intubation equipment with drugs in 52% of cases and no equipment at all in 36% of hospitals. In these last cases, the crash team relies on the equipment available in the wards, but only 75% of them have protocols to check it regularly. In 20% of hospitals there is a defibrillator in every ward, in 24% there is one defibrillator per floor and in 56% less than one per floor. In 79% of these last cases, the crash team does not carry the defibrillator, which has to be found by the personnel in other ward of the same floor or in other floors of the hospital, and has to be carried by hand or by elevator. In two hospitals a transthoracic emergency pacemaker is not available; in only one hospital the pacemaker is included in the crash cart carried by the emergency team; in the remaining cases, it is available, but it has to be found in CCU, ITU or OR.

Fifty-six percent of hospitals do not have standard ALS protocols; 28% have them, while in 16% of hospitals some providers use them, others do not. Only in two hospitals the Utstein style for reporting cardiac arrest is used.

Despite the fact that the majority of hospitals have a regular BLS training programme for the personnel, in 88% of hospitals the emergency team members complained of insufficient CPR training of general ward personnel, on which they rely to perform ALS on arrival.

The time for arrival in the farthest ward of the hospitals ranges from 30 s to more than 15 min (average 3 min 30 s ± 4 min 27 s SD). The majority of hospitals are on a single building with less than six floors, but seven of them have separate buildings, and two have 11 floors.

Conclusions

The majority of hospitals in Rome do not have a dedicated telephone number for emergencies and do not use international ALS protocols for cardiac arrest treatment. Only in 12% of cases the crash team carries a complete ALS equipment on the scene, while the majority of ALS teams prefer to move with a limited equipment, relying on materials available on the wards. However, only in 20% of hospitals there is a defibrillator in every ward. In the majority of hospitals there is regular training on CPR for general ward personnel, but the majority of emergency team members complaint of insufficient CPR training of general ward personnel.