Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team

Objective: To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. Methods: This is a “three-phase” (organized, transitional, and re-organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re-organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age). Results: The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase ( P=0.013). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re-organized teams ( P=0.007). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods ( P=0.406). The chance of survival-to-discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re-organized period ( P=0.496). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35–4.80) and witness at the scene (odds ratio: 2.45, 95% confidence interval: 1.34–4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis. Conclusion: The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients. Objectivo: Avaliar o impacto de uma equipa de reanimação estruturada e formal no departamento de emergência (DE), na taxa de sucesso da reanimação cardio-pulmonar (CPR) das vı́timas de paragem cardı́aca extra-hospitalar (OHCA). Métodos: Este é um estudo prospectivo em “três fases” (Organizar, transição, re-organizar), no qual foram revistos os registos médicos de todas as vı́timas de OHCA que necessitaram de reanimação no DE durante os 3 perı́odos de 6 meses, e os dados foram registados num formato estilo Utstein extra-hospitalar. Existia uma equipa de reanimação organizada nas fases organizar e re-organizar, mas nã