Physician Compliance With Advanced Cardiac Life Support Guidelines

Study objective: To determine compliance with advanced cardiac life support (ACLS) guidelines among ACLS-certified and non-ACLS-certified physicians. Design: Retrospective review of consecutive cardiac arrests between July 1989 and June 1990, including assessment of the resuscitation leaders' ACLS certification. Setting and participants: All nontraumatic prehospital and hospital cardiac arrests in a rural university hospital. Results: Two hundred seven arrests were studied for a total of 436 rhythms with a maximum of 4 rhythms per arrest. There were 78 resuscitations (36.3%) with return of spontaneous circulation. A total of 2,038 interventions were recorded for all rhythms, with 1,320 (64.8%) compliant with ACLS guidelines compared with 718 (35.2%) deviations. Synchronized cardioversion, calcium chloride and sodium bicarbonate were used with significantly higher noncompliance. Ventricular fibrillation had significantly higher mean rhythm deviation scores, whereas scores were significantly lower for sinus rhythm and stable bradycardia ( P