Hypothesis-generating study on the effect of the ACLS guidelines on the use of atropine in cardiac arrest at a community hospital

Background: Barriers exist in translating clinical practice guidelines into medical management of patients. These barriers result in delay in translating the Advanced Cardiac Life Support (ACLS) guidelines into clinical practice. We conducted a pilot study employing the recommendation change in atropine usage in the 2010 ACLS guideline algorithm to examine the time lag in translating guidelines into medical practice. Methods and results: We completed a retrospective chart review at a community hospital. Study data was derived from cardiac arrest records from the emergency department between January 1, 2009 and December 31, 2013, before and after the publication of the 2010 ACLS guidelines. All cardiac arrests in the form of asystole and/or pulseless electrical activity at some time during resuscitation in patients aged 19 years and older were included in the study. We examined whether atropine was used during the resuscitation. We studied the use of epinephrine as a control. A time versus atropine and a time versus epinephrine usage graphs were generated and examined. Fifty-five resuscitations met inclusion criteria. Although the 2010 ACLS guidelines were first presented in October 2010, we observed that change in atropine use occurred around the summer of 2011. There was no change in the use of epinephrine. Conclusion: Despite several guideline dissemination strategies, a time lag was found in physicians' adaptation of the ACLS guidelines.