Date of Award

2019-1

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN, Committee Member; Ruth Bush, PhD, MPH, FAMIA, Committee Member

Keywords

resuscitation, cardiac arrest, code nurse, code blue, Benners Theory

Abstract

Background: Despite advancements in resuscitation efforts, sudden cardiac arrest remains the third leading cause of death in the United States, with approximately 200,000 adult cardiac arrests occurring in the hospital setting. Nearly 50% of the patients who experience an inhospital cardiac arrest (IHCA) achieve a return of spontaneous circulation (ROSC); nonetheless, only 20% of IHCA patients survive to hospital discharge. With these compromised outcomes, it is important to understand the numerous factors surrounding resuscitation efforts for in-patient cardiac arrest. The conceptual framework comprises pre-arrest and intra-arrest variables influence on the survival outcome of ROSC. The purpose of this study was to examine the relationships between risk factors (time of day of arrest, day of the week of arrest, patient characteristics [age and gender], shockable rhythm, code nurse experience) and ROSC for patients who experienced an inpatient cardiac arrest.

Methods: A retrospective, cross-sectional design. Two secondary data sets provided data for this study. Data set 1 contained resuscitation data of patients who had experienced an IHCA at a southern California tertiary academic medical center between July 2014 and October 2016; data set 2 contained code nurse experience variables. Data analyses included descriptive and inferential statistics

Results: 307 cardiac arrests: 63.2% occurred during the week, 57% during the day, 63.2% male, and 81.1% were non-shockable rhythms. Code nurses primarily had expert levels of experience for years as a nurse (n=257, 83.7%) and ART training (n=192, 62.5%). Patients achieved ROSC 78.5% (n=241) of the time. Logistic regression containing 3 independent variables (age, gender, and shockable rhythm) trended toward being statistically reliable distinguishing ROSC [-2LogLikehood = 312.214, X2(3), = 7.364, p

Implications: Advances in improving IHCA survival outcomes continue, nonetheless, large numbers of annual arrests suggest there is still substantial room for improvement. This study found the only factor that influenced a patient’s survival is whether they presented with a shockable rhythm during the arrest. Study limitations support future research is warranted to replicate and identify other related factors with larger samples.

Document Type

Dissertation: USD Users Only

Department

Nursing

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