The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [387]
The Resuscitation Council (UK) guidelines state that if rescuers are not able, or are unwilling, to give rescue breaths, they should give chest compressions alone (Resuscitation Council 2010b).
Whenever CPR is carried out (outside the hospital setting), particularly on an unknown victim, there is some risk of cross-infection, associated particularly with giving rescue breaths. Normally, this risk is very small and has to be set against the inevitability that a person in cardiac arrest will die if no assistance is given.
Competencies
Cardiopulmonary resuscitation standards and training
The Resuscitation Council UK (RCUK), formed in 1981, aims to promote the education of lay and professional personnel in the most effective methods of resuscitation appropriate to their needs. In its report CPR Guidance for Clinical Practice and Training in Hospitals (Resuscitation Council 2004), the Council made a number of recommendations relating to the provision of a resuscitation service in hospital.
Resuscitation committee. This should comprise medical and nursing staff who advise on the role and composition of the cardiac arrest team, resuscitation equipment and resuscitation training equipment.
Resuscitation Training Officer (RTO), who should be responsible for training in resuscitation, equipment maintenance and the auditing of resuscitation/clinical trials.
Resuscitation training. Hospital staff should receive at least annual resuscitation training appropriate to their level and role. Medical and nursing staff should receive basic resuscitation training and should be encouraged to recognize patients who are at risk of having a cardiac arrest and call for appropriate help early. This is the most effective method of improving outcome (Jevon 2002). All medical staff should have advanced resuscitation training and senior nurses and doctors working in acute specialities (CCU, ITU, A&E) should hold a valid RCUK ALS certificate.
Cardiac arrest team. Each hospital should have a team of approximately five people including a minimum of two doctors (physician and anaesthetist), an ALS-trained nurse, the RTO and a porter when possible. Clear procedures should be available for calling the cardiac arrest team. The Resuscitation Council has recommended the development of a medical emergency team which recognizes patients at risk of having a cardiac arrest and initiates the most appropriate clinical intervention to prevent it (Jevon 2002). The development of Track and Trigger systems and MEWS (modified early warning system) alerts nurses to when a patient is deteriorating so that they can initiate interventions and early referral to critical care outreach teams or medical emergency teams (DH 2000, NICE 2007). Hospital staff are often trained in BLS techniques (see Figure 10.26) that are more appropriate for the single lay rescuer in an out-of-hospital environment. These new guidelines are aimed primarily at healthcare professionals who are first to respond to an in-hospital cardiac arrest (Figure 10.33). Some of the guidelines are also applicable to healthcare professionals in other clinical settings (Resuscitation Council 2004).
Figure 10.33 In-hospital resuscitation algorithm. CPR, cardiopulmonary resuscitation; IV, intravenous.
Courtesy of Resuscitation Council (2010b).
Preprocedural considerations
Equipment
All hospital wards and appropriate departments, for example theatre, computed tomography (CT) scanning, should have a standardized cardiac arrest trolley or box. Resuscitation equipment should be checked on a daily basis (Resuscitation Council 2010b) by the staff on the wards or clinical areas responsible for it, and a record of this check should be maintained. Defibrillators should also be standardized. The use of AEDs or shock advisory defibrillators is recommended to reduce mortality from cardiac arrests related to ischaemic heart disease (Jevon 2002). Bossaert (1997) recommends