In-hospital Cardiopulmonary Resuscitation during Asystole
Therapeutic Factors Associated with 24-hour Survival
The efficacy of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrests has been studied at a number of hospitals since its introduction in I960. These studies have identified some of the demographic and clinical characteristics associated with outcome, as well as some of the sequelae of successful resuscitation. In light of the obvious logistic difficulties involved in conducting this kind of research, it is not surprising that few studies have systematically examined the efficacy of the various therapeutic interventions employed during in-hospital CPR as a function of specific arrest characteristics. fully
However, despite this paucity of clinical research, the need for consistent procedures and training methods has led the American Heart Association and other organizations to establish standards and guidelines for CPR. The specificity of these standards and guidelines has evolved through the accumulation of clinical experience and an increasing body of experimental data. As a result, the most recent publication of the AHA guidelines includes separate procedures for resuscitation of arrests characterized by different cardiac rhythms. The AHA guidelines for asystole recommend a course of action which includes IV administration of epinephrine and atropine, and in some instances, the insertion of a pacemaker and/or the use of additional drugs.
It is important to point out that asystolic arrests are often the end product of agonal states or prolonged, unwitnessed arrests. However, there is a body of evidence which suggests that asystole can be the primary event of arrest particularly in nondiseased hearts. The study reported here focused on patients in whom asystole was the initial rhythm recorded at the time CPR was begun. This study examines the relationship between CPR outcome and demographic, clinical, and arrest characteristics, as well as the relative efficacy of specific therapeutic interventions. Comparisons between survival rates of those patients in whom CPR included the procedures recommended by the AHA and those in whom additional interventions were used were of particular interest.