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Objectives In‐Hospital Cardiac Arrests

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Objectives In‐Hospital Cardiac Arrests 9/21/2017 Streamlining the Crash Cart Model: Less is More Elizabeth Short, Pharm.D., BCCCP* Pharmacy Practice Coordinator‐ Clinical Services (non‐oncology) PGY1 Residency Coordinator Northwestern Memorial Hospital Chicago, Illinois *No conflicts of interest to disclose Objectives • Pharmacist 1. Identify resuscitation processes that are critical to survival from sudden in‐hospital cardiac arrest. 2. Describe the role of the pharmacist in a mobile crash cart model. • Technician 1. Identify the two most important steps in a cardiac arrest. 2. Explain the difference between a standard crash cart model and a mobile crash cart model. In‐hospital Cardiac Arrests • In‐hospital 1 – Incidence: 209,000 – Survival rate: 24.8% • Chicago airports 2 – Incidence: 18 – Survival rate: 61% • 100% received chest compressions • Time to shock < 5 minutes in 2/3 of people 1. http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac‐Arrest‐Statistics.jsp 2. Sherry L. Caffrey. N Engl J Med. 2002 Oct 17;347(16):1242‐7. 1 9/21/2017 Chain of Survival • Successful resuscitation requires early 1 – Recognition of cardiopulmonary arrest – Activation of trained responders – Chest compressions – Defibrillation when indicated – Advanced life support (ALS) 1. http://circ.ahajournals.org/content/95/8/2211 Chain of Survival • Goal – To safely and efficiently improve the resuscitation process • Metrics – Number and severity of incident reports related to insufficient supplies – Percent of patients defibrillated within two minutes of recognition of cardiac arrest 1,2 1. Ewy GA, Ornato JP. J Am Coll Cardiol. 2000 Mar 15;35(4):832‐46. 2. Cummins et al. Circulation. 1991 May;83(5):1832‐47. Defibrillation • Delayed defibrillation1 – More than two minutes after the arrest – Nationally reported to occur in 30% patients – Associated with lower probability of survival to discharge 1. Committee on the Treatment of Cardiac Arrest, National Academies Press (US); 2015 Sep 29. 2 9/21/2017 Problem • Delays in cardiac rhythm analysis and defibrillation • Unit‐based crash cart maintenance Ideal Set‐Up Actual Set‐Up Solution • Replace semi‐automatic Automated External Defibrillators (AEDs) with fully automatic public access defibrillators (PADs) • First responder to perform cardiopulmonary resuscitation (CPR) and defibrillate when appropriate prior to arrival of cardiac arrest team Solution • Eliminate crash carts • Replace with a mobile crash cart – Streamlines supplies – Kit of emergency medications placed in all automated dispensing cabinets (ADCs) – Pharmacist supplies and assists with medications 3 9/21/2017 Key Points • Implement a mobile crash cart model with simpler public access AEDs • Perform CPR and defibrillate when appropriate prior to arrival of cardiac arrest response team • Pharmacist takes ownership of all medications 4 9/21/2017 Post‐Test Question: Pharmacist In‐hospital cardiac arrest resuscitations require which of the following? A. Rapid hospital staff recognition of cardiac arrest B. Rhythm identification C. Prompt mobilization of defibrillator therapy D. All of the above Post‐Test Question: Pharmacists What is the role of the pharmacist at an in‐hospital cardiac arrest? A. Deliver medications for the arrest team to use at their discretion B. Responds after the arrest is over to replace used medications C. Take ownership of and manage all medications D. The pharmacists is not part of the cardiac arrest response team Post‐Test Question: Technicians The two most important steps during resuscitation of a ventricular fibrillation cardiac arrest are chest compressions and time to: A. advanced airway placement B. defibrillation C. epinephrine administration D. lidocaine administration 5 9/21/2017 Post‐Test Question: Technicians The primary aim of changing from a standard crash cart model to a mobile crash cart model is to: A. improve time to AED application and use if necessary B. improve time to medication administration C. increase cardiac ultrasound use D. reduce supply costs 6.
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