Australian hospitals need to make better use of cardiac arrest resources

Policy in Australian hospitals does not reflect the fact that the time between patient collapse and restoration of heart rhythm is the single most important determinant of cardiac arrest outcome, according to research published in the latest issue of the Medical Journal of Australia.

Judith Finn RN PhD, Senior Lecturer in Clinical Epidemiology and Ian Jacobs RN PhD, Associate Professor in Emergency Medicine at The University of Western Australia, report findings in the first national survey on equipment, training, practices and policies relating to cardiopulmonary resuscitation (CPR) and defibrillation in cardiac arrest in Australian hospitals.

All 665 responding hospitals provide CPR training for their nursing staff. However, only

55 per cent of hospitals provide CPR training for doctors. "Several nursing respondents commented that CPR training for medical officers was 'offered, but refused'," said Dr Finn.

Dr Finn said over 100 hospitals with a defibrillator still do not allow nurses to defibrillate, including hospitals where there is no medical officer on-site and hospitals with automated external defibrillators (AEDs).  This is contrary to the recommendations of major international resuscitation bodies, including the Australian Resuscitation Council.

"Hospital policies and procedures need to be reviewed immediately to reduce the crucial interval between cardiac arrest and defibrillation.  In most instances this can best be reduced by nurses at the scene being expected to defibrillate," said Dr Finn.

Most hospitals (88 per cent) stated that they follow the Australian Resuscitation Council guidelines, but there were several comments expressing confusion about the differences between the various resuscitation organisations' policies.

In an editorial commenting on the research, Michael O'Rourke, Professor of Medicine at the University of New South Wales, and Sian Davies RN, Manager of the English Government National Defibrillation Program, said the article by Finn and Jacobs challenges medical professions to find better ways of dealing with sudden unexpected cardiac arrest in the nation's hospitals. 

"It underscores the important role played by nurses, and the problem that needs to be addressed by nurses through their influence within our hospitals," said Professor O'Rourke.

Professor O'Rourke said that a wide range of published data suggests that cardiac arrest is more likely to be successfully treated in Chicago or Heathrow Airport, or in a Boston post office, than in the vestibules, corridors or general wards of Australia's premier hospitals.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:  Research:   Dr Judith Finn, 08 9371 6588 (h)  0417189841

               Editorial:      Professor Michael O'Rourke, 08 8382 6877 (w)  02 9879 6205 (h)  0410 327 100

               AMA:           Judith Tokley, 02 6270 5471 (w)  0408 824 306