In-hospital cardiac arrest is an emergency situation that requires teamwork and the appropriate sequential actions to rescue the patients.[4
] The outcome of cardiac arrest and CPR is dependent on critical interventions, particularly early defibrillation, effective chest compressions and assisted ventilation.[5
] Over the last 50 years, after the introduction of modern CPR, there have been major developments and changes in the performance of resuscitation.[6
] But, despite considerable efforts to improve the treatment of cardiac arrest, most reported survival outcome figures are poor.[5
] Even in the hospitalised patients, the rate of successful CPR has been reported by some studies to be as low as 2–6%, although most studies report successful CPR outcome in the range of 13–59%.[6
The lack of resuscitation skills of nurses and doctors in basic and advanced life support has been identified as a contributing factor to poor outcome in cardiac arrest victims.[8
] In an effort to improve cardiac arrest outcomes, recent investigations have focussed on the timing and quality of CPR. Several guidelines on performing CPR have been published and certified training courses based on these guidelines have become a standard in medical professionals’ training in many parts of the world.[1
] The aim of these courses is to provide information and hands-on practice in the management of periarrest situations in accordance with the latest guidelines.
Although life support courses are widely advocated, their effectiveness has been little studied. Very few studies are available in the literature on comparative CPR outcomes after formal resuscitation training. An in-hospital investigation demonstrated that cardiac arrest detected by an ACLS-trained nurse was strongly associated with a four-fold increase in survival to discharge (38% vs. 10%) than those detected by a nurse without ACLS training.[9
] This indicates that ACLS-trained nurses provided an independent contribution to increased survival rate.
The results of the present study show that the rate of immediate survival was 18.3% during the pre-BLS/ACLS period, which increased to 28.3% during the post-BLS/ACLS period. The rates of ROSC during both the study periods were not much different from those of previous studies of in-hospital cardiac arrests.[3
] But, our study clearly shows an improved rate of immediate survival after the formal BLS/ACLS training (P
< 0.005). A Brazilian study by Moretti et al
. also shows a significant increase in ROSC from 27.1% to 43.4% even on inclusion of a single ACLS-trained personnel in the resuscitation team.[12
] Another study by Sanders’ also reported improved resuscitation success in a rural community hospital after an ACLS provider course.[13
] A study by Borimnejad et al
. also showed that initial survival after CPR improved significantly with the CPR-trained emergency team (18.4–30%).[6
Although a previous study by Olasveengen reported a weak trend with survival to discharge rates improving only from 11% to 13% after implementation of the modified 2005 CPR guidelines, the study by Moretti et al
. reported a statistically significant increase in survival to discharge in patients resuscitated by the CPR team having an ACLS-trained personnel versus the team having no ACLS personnel (20.6% vs. 31.7%).[6
] Our study also reports markedly improved survival to hospital discharge rates (23.1% vs. 69.1%) after formal BLS/ACLS training (P
< 0.0001). The survival to discharge rates during the pre-BLS/ACLS period of our study are almost comparable to that reported in the literature (11.7–32.2%), but the significant increase in survival to discharge rates after the BLS/ACLS training to 69% highlights that formal training of code blue team members enormously improved the skills of CPR and their level of competence in resuscitation.[1
] This also shows that the quality of CPR performed might be better after ACLS training. This highlights the importance of certified hands-on training program on the outcome of resuscitation.
Limitations of the study
A few limitations of our study should be acknowledged. First, because this study was conducted at a single institution, external validity is relative and uncertain. Thus, other multicenter studies are required to ascertain the validity. Second, our results might be biased because of increased attention on resuscitation during the post-training period.