Nurses as essential members of an effective in-hospital cardiac resuscitation team

Abstract

© Journal of Hospital Management and Health Policy. All rights reserved. J Hosp Manag Health Policy 2020;4:17 | http://dx.doi.org/10.21037/jhmhp-20-18 In-hospital cardiac arrest (IHCA), defined as loss of circulation prompting resuscitation with chest compressions, defibrillation, or both, is an increasingly common event affecting healthcare systems worldwide (1). The Get With The Guidelines-Resuscitation (GWTG-R) registry, a large, prospective, hospital-based clinical registry, documented an average of 209,000 cases of IHCA each year in the United States between 2003 and 2007, with an increase to 292,000 per year between 2008 and 2017 (1,2). Survival rates for IHCA remain poor (3,4) with average survival rates of about 26% among 311 hospitals in the United States in 2017 (2). The rate of survival to hospital discharge after cardiac arrest varies among medical centers and is higher in hospitals with higher cardiac arrest volume, higher surgical volume, greater availability of invasive cardiac services, and more affluent catchment areas (2). Among those surviving to hospital discharge, 81.7% were considered to possess good functional status as evidenced by a cerebral performance category of 1 or 2 (2), representing mild or no neurologic disability to moderate neurologic disability (5). A significant difference in survival rates exists across hospitals in the United States, with survival rates ranging from 5.3–49.6% (3,6). This wide variation is present despite published guidelines by the American Heart Association (AHA) for the management of cardiac arrest. Even with guidelines in place, implementation of recommended procedures during IHCA has proved difficult as these events take place in varied environments with complex and diverse medical issues and require the collaboration of a multidisciplinary team to achieve successful outcomes. There are several factors involved and multiple steps are needed to ensure effective management of an IHCA patient. The initial step in the evaluation and treatment of IHCA requires timely identification of the cardiac arrest event and the underlying cause. When a cardiac arrest occurs, early appropriate initiation of cardiopulmonary resuscitation (CPR) with quality chest compressions and thorough postresuscitation care are crucial to a positive outcome (1,5,7). In approximately 50–60% of cases, the underlying cause is cardiac in nature, whereas 15–40% are due to respiratory insufficiency (1) and appropriate care is needed for each of the underlying conditions and modifying factors to prevent deterioration that might lead to cardiac arrest. Development of a dedicated cardiac arrest or code team is essential. Top-performing hospitals are found to have dedicated or designated resuscitation teams with additional support staff (i.e., nursing, pharmacy, clerical, spiritual staff), clear patterns of communication between team members, and specific training and education around resuscitation (7). Although ample research has been performed regarding procedural techniques for the evaluation and management of IHCA, investigation into healthcare professionals’ roles, Editorial Commentary