In-hospital resuscitation: association between ACLS training and survival to discharge

Context: No data have been published on the relationship between advanced cardiac life support (ACLS) training of the individual who initiates resuscitation efforts and survival to discharge. Objective: To determine whether patients whose arrests were discovered by nurses trained in ACLS had survival rates different from those discovered by nurses not trained in ACLS. Design: Cohort case-comparison. Setting: A 550-bed, tertiary care center in central Georgia. Subjects: Patients whose cardiopulmonary arrest was discovered by a nurse who activated the in-hospital resuscitation mechanism. Main outcome measure: Patient survival to discharge. Results: Initial rhythm was strongly related to survival to discharge and individually associated with 57% of the variability in survival. Nurse's training in advanced cardiac life support was also strongly related to survival and individually associated with 29% of the variability. Combining both the variables determined 62% of the variability in survival to discharge. Patients discovered by an ACLS-trained nurse ( n=88) were about four times more likely to survive (33 survivors, 38%) than were patients, discovered by a nurse without training in ACLS ( n=29, three survivors, 10%). Conclusion: Arrest discovery by nurses trained in ACLS is significantly and dramatically associated with higher survival-to-discharge rates.