Management of ventricular fibrillation by doctors in cardiac arrest teams

BMJ 1994; 309 doi: (Published 26 November 1994) Cite this as: BMJ 1994;309:1408
  1. K Y Tham, honorary registrara,
  2. R J Evans, senior registrara,
  3. E J Rubython, senior house officera,
  4. T D Kinnaird, senior house officera
  1. a Accident and Emergency Department, Cardiff Royal Infirmary, Cardiff CF2 1SZ
  1. Correspondence to: Mr Evans.
  • Accepted 5 July 1994

Successful management of a cardiac arrest in accident and emergency departments or other specialised hospital units can be expected to result in a survival rate of around 50% initially and around 20% after one year.1 The protocol for managing ventricular fibrillation and the importance of rapid defibrillation were emphasised in the European Resuscitation Council guidelines 1992 on advanced life support.2 3 We investigated knowledge of these guidelines among doctors in cardiac arrest teams with respect to the management of ventricular fibrillation.

Methods and results

In December 1993 and January 1994 we conducted a telephone survey of 113 doctors in the cardiac arrest teams from 62 teaching and district hospitals in England and Wales. These hospitals were randomly selected from the 1993 directory of the British Association for Accident and Emergency Medicine. The doctors carrying cardiac arrest pagers were contacted consecutively on the same day through their hospital operators to prevent discussion between them. They were asked about management of a witnessed cardiac arrest due to ventricular fibrillation, practical training for cardiopulmonary resuscitation within the previous year, knowledge of the European Resuscitation Council guidelines, whether they were certified providers of advanced cardiac life support or advanced life support, and postgraduate qualifications. Each doctor's management of ventricular fibrillation was compared with the protocol stipulated in the council's guidelines.

The results were analysed by X2 analysis. We contacted 113 doctors, all of whom agreed to participate in the survey. Twenty were registrars, 50 senior house officers, and 43 house officers. Fifty six doctors led the cardiac arrest team.

Thirty two doctors knew the full sequence of managing ventricular fibrillation, and 49 knew the initial management; 32 were unable to state correctly the initial management. Minor mistakes such as omitting the precordial thump were ignored. The major mistakes are shown in the table.

Major mistakes in initial management of ventricular fibrillation among 113 doctors

View this table:

Seventy seven doctors had had practical training within the previous year, of whom 59 knew the management of ventricular fibrillation. Thirty six did not have practical training, of whom 22 knew the management sequence. This difference (15.5%) (95% confidence interval -30.1% to 34%) was not significant. Team leaders and members and different grades of doctors did not differ significantly in their knowledge of the management of ventricular fibrillation. Seventy nine doctors had heard of certified courses in life support but only eight were certified providers. Only 45 knew that the guidelines were those of the European Resuscitation Council. Forty eight doctors were taught the guidelines at inhouse training programmes, most of which were induction courses for junior doctors. Forty eight had read the guidelines in material from inhouse training programmes, 30 had read them in publicity material such as wall posters, 27 had read them in the BMJ; eight had read them elsewhere or could not recall the source.


The resuscitation skills of preregistration house officers and candidates for the MRCP examination are poor.4 5 The need for practical training and revision has long been recognised. We studied the doctors in cardiac arrest teams, who would be expected to be thoroughly conversant with the new guidelines on advanced life support. It is therefore surprising that less than a third of them could recall the full sequence of management of ventricular fibrillation. Doctors who had had practical training seemed better versed in managing ventricular fibrillation than those who had not, though the difference was not significant.

Most of the hospitals surveyed provide practical training for their preregistration house officers. The aim now should be that all grades of doctors are given advanced life support training, continued training, and the opportunity to rehearse cardiac arrest procedures. Certified life support courses provide excellent training, yet the proportion of doctors surveyed who had had such training was small. Ideally, all members of cardiac arrest teams should be certified providers of life support techniques, but we suggest that at least the team leader should have such training.



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