In-hospital resuscitation: association between ACLS training and survival to discharge


      Context: No data have been published on the relationship between advanced cardiac life support (ACLS) training of the individual who initiates resuscitation efforts and survival to discharge. Objective: To determine whether patients whose arrests were discovered by nurses trained in ACLS had survival rates different from those discovered by nurses not trained in ACLS. Design: Cohort case-comparison. Setting: A 550-bed, tertiary care center in central Georgia. Subjects: Patients whose cardiopulmonary arrest was discovered by a nurse who activated the in-hospital resuscitation mechanism. Main outcome measure: Patient survival to discharge. Results: Initial rhythm was strongly related to survival to discharge and individually associated with 57% of the variability in survival. Nurse's training in advanced cardiac life support was also strongly related to survival and individually associated with 29% of the variability. Combining both the variables determined 62% of the variability in survival to discharge. Patients discovered by an ACLS-trained nurse (n=88) were about four times more likely to survive (33 survivors, 38%) than were patients, discovered by a nurse without training in ACLS (n=29, three survivors, 10%). Conclusion: Arrest discovery by nurses trained in ACLS is significantly and dramatically associated with higher survival-to-discharge rates.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kouwenhoven W.B.
        • Jude J.R.
        • Knickerbocker G.G.
        Closed-chest cardiac massage.
        J. Am. Med. Assoc. 1960; 173: 1064-1067
        • Parish D.C.
        • Dane F.C.
        • Montgomery M.
        • Wynn L.J.
        • Durham M.D.
        Resuscitation in the hospital: differential relationships between age and survival across rhythms.
        Critical Care Med. 1999; 27: 2137-2141
        • Utstein Style Writing Group
        Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital Utstein style.
        Ann. Emerg. Med. 1997; 29: 650-679
        • Schneider A.P.
        • Nelson D.J.
        • Brown D.D.
        In-hospital cardiopulmonary resuscitation: a 30-year review.
        J. Am. Board Family Phys. 1993; 6: 91-101
        • McGrath R.B.
        In-house cardiopulmonary resuscitation–after a quarter of a century.
        Ann. Emerg. Med. 1987; 16: 1365-1368
        • Cohn E.B.
        • Lefevre F.
        • Yarnold P.R.
        • Arron M.J.
        • Martin G.J.
        Predicting survival from in-hospital CPR: meta-analysis and validation of a prediction model.
        J. Gen. Intern. Med. 1993; 8: 347-353
        • Jastremski M.S.
        In-hospital cardiac arrest.
        Ann. Emerg. Med. 1993; 22: 113-117
        • Camp B.N.
        • Parish D.C.
        • Andrews R.H.
        The impact of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital.
        Ann. Emerg. Med. 1997; 29: 529-533
        • Fitzgerald J.D.
        • Wenger N.S.
        • Califf R.M.
        • Phillips R.S.
        • Desbiens N.A.
        • Liu H.
        • Lynn J.
        • Wu A.W.
        • Connors A.F.
        • Oye R.K.
        Functional status among survivors of in-hospital cardiopulmonary resuscitation.
        Arch. Intern. Med. 1997; 157: 72-76
        • Miranda D.R.
        Quality of life after cardiopulmonary resuscitation.
        Chest. 1994; 106: 524-530
        • Fifield D.H.
        Outcomes of resuscitative efforts at Wild Rose Hospital.
        Wisconsin Med. J. 1994; 93: 55-57
        • Schultz S.C.
        • Cullinane D.C.
        • Pasquale M.D.
        • Magnant C.
        • Evans S.
        Predicting in-hospital mortality during cardiopulmonary resuscitation.
        Resuscitation. 1996; 33: 13-17
      1. Terrace, IL. Comprehensive accreditation manual for hospitals. Joint Commission on Accreditation of Healthcare Organizations, 1996.

        • Lowenstein S.R.
        • Sabyan E.M.
        • Lassen C.F.
        • Kern D.C.
        Benefits of training physicians in advanced cardiac life support.
        Chest. 1986; 89: 512-516
        • Sanders A.B.
        • Berg R.A.
        • Burress M.
        • Genova R.T.
        • Kern K.B.
        • Ewy G.A.
        The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.
        Ann. Emerg. Med. 1994; 23: 56-59
        • Pepe P.E.
        • Brown C.G.
        ACLS–does it really work?.
        Ann. Emerg. Med. 1994; 23: 1037-1041
        • Nayak A.
        Cummins R. Textbook of advanced cardiac life support. American Heart Association, Dallas1994
        • Vrtis M.
        Cost/benefit analysis of cardiopulmonary resuscitation: a comprehensive study, Part II.
        Nursing Manage. 1992; 23: 44-51
        • Phillips D.F.
        • Halebsky S.C.
        The epidemiology of found experiments.
        J. Am. Med. Assoc. 1995; 273: 1221