EVALUATION OF ADVANCED CARDIAC LIFE-SUPPORT IN A COMMUNITY TEACHING HOSPITAL BY USE OF ACTUAL CARDIAC ARRESTS

Objective: To determine the retention of Advanced Cardiac Life Support training of internal medicine residents as a function of the time since successfully completing ACLS training. Design: Prospective, consecutive sample of patients who underwent a cardiopulmonary resuscitation effort directed by physicians who successfully completed ACLS. Setting: Eastern community teaching hospital. Patients: 180 consecutive patients over the age of 18 years who sustained a cardiopulmonary arrest and whose resuscitation efforts were directed by physicians who successfully completed ACLS. Forty-five additional resuscitative efforts hospital wide were led by non-ACLS-trained physicians during the study period. Outcome Measures: Correctness of the diagnosis of rhythms and treatment of the rhythms diagnosed were assessed, as per ACLS protocols in effect at the time of the study, in 1991. Intervention: None. Results: Chi-squares were used for analysis. Seventy-six of the resuscitative efforts were run by medical residents with a 13.2% error rate. The error rate in the first 6 months after ACLS completion among residents was 5.1%, as compared with 21.6% in the next 6 months (p = 0.033), with no impact on actual survival rate. During the study period, error rates among other groups were 8.8% in Emergency Department physicians and 17.8% among non-ACLS-trained physicians. Conclusions: The error rate found was lower than in previous studies evaluating retention of ACLS education. It is important to have regular updates in ACLS to ensure proper protocol use.