Does standardized mega-code training improve the quality of pre-hospital advanced cardiac life support (ACLS)?

Abstract

The aim of our prospective study was to evaluate the effects of a standardized mega-code and arrhythmia training upon process elements of quality of pre-hospital advanced cardiac life support provided by a physician-staffed mobile intensive care unit. In 145 cases of adult cardiac arrest due to cardiac aetiology, time intervals from arrival of the mobile intensive care unit at the patient's side until first ECG diagnosis, first defibrillation, endotracheal intubation, and first epinephrine administration were measured with on-line tape recording, prior to, and following a standardized 8-h arrhythmia and mega-code training. Following the training, patients with asystole or pulseless electrical activity were intubated 1.1 min earlier (P = 0.03), and received epinephrine 1.3 min earlier (P = 0.01) than prior to the training. There were no significant differences in time intervals concerning management of ventricular fibrillation or tachycardia. Neither admission nor discharge rates differed significantly before and after the training. Thus, practical training including rhythm analysis and mega-code session improved the performance of our mobile intensive care unit in cases of asystole and pulseless electrical activity, and, hence, process elements of quality.