Pharmacist impact on advanced cardiac life support compliance during in-hospital cardiac arrest

Introduction: The Advanced Cardiac Life Support (ACLS) guidelines, endorsed by the American Heart Association, are universally employed due to their clear pathways for use of evidence based treatments. Studies have shown that physician compliance with the ACLS guidelines is less than 65%. In these circumstances the expertise of a pharmacist may help optimize drug dosing, selection, timing and administration.

Objectives: The purpose of this study is to investigate whether pharmacist presence during a cardiac arrest affected ACLS guideline compliance.

Study Design: This is a retrospective chart review of hospitalized patients who experienced cardiac arrest at a community hospital between September 1, 2014 and August 31, 2015.

Methods:

Patients were included if they were over the age of 18 and had an in-hospital cardiac arrest. The patients were excluded if there was no detailed flow sheet documenting the occurrences, or if the cardiac arrest began prior to arrival. The primary objective was to compare compliance with ACLS guidelines during cardiac arrest when a pharmacist was present compared to cardiac arrests when no pharmacist was present. Data was collected from cardiac arrest code sheets and the electronic medical record system. Student’s t-test was utilized to evaluate continuous data and Fisher’s exact test was utilized for nominal data.

Results:

A total of 235 cardiac arrests met inclusion criteria. Of those, 34 had documented pharmacy presence while 201 had no pharmacist present. Overall compliance was maintained in 25 out of 34 (73.5%) cardiac arrests in the pharmacist arm compared to 79 out of 201 (39.3%) in the no pharmacist arm (p<0.001). A total of 204 deviations occurred. 14 deviations (42 per 100 arrests) occurred with a pharmacist present and 190 deviations (94 per 100 arrests) occurred when no pharmacist was present (p<0.001). 

Conclusions: Pharmacist presence significantly increased compliance with the ACLS guidelines.