Preparedness of Radiology Departments in Kenyatta National Hospital and University of Nairobi Department of Diagnostic Imaging and Radiation Medicine to Adequately Manage Cardiopulmonary Arrest Events

Abstract

Study Background: Cardiopulmonary arrest refers to the sudden loss of heart function and is a common occurrence in the hospital and associated with a high mortality rate. The radiology department is one of the areas in the hospital where cardiopulmonary arrest events may occur with some studies showing worse patient outcomes when the events occur during radiological procedures. The chances of survival after cardiopulmonary arrest are heavily dependent on the rapid initiation of the chain of survival which forms the basis for life support training courses including Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS) and Advanced Radiology Life Support (ARLS). Practice of the guidelines has been shown to not only facilitate timely decision making but also to positively impact the morbidity and mortality rate following cardiopulmonary arrest events. For radiology departments to adequately manage these events, the staff needs to be up to date on current life support guidelines and well equipped to practice them. Few studies have been carried out to assess the management of cardiopulmonary arrest in radiology departments locally. Broad Objective: To evaluate the preparedness of radiology departments in Kenya to adequately respond to cardiopulmonary arrest events by assessing staff attitudes and knowledge levels on basic and advanced life support, certification status and availability of the necessary resuscitation equipment. Study design and sites: An observational, cross-sectional study conducted in radiology departments in Kenyatta National Hospital (KNH) and University of Nairobi Department of Diagnostic Imaging and Radiation Medicine (UoN-DDIRM). Participants and method: Study subjects were 75 health professionals including radiologists (12%), radiology residents (34.7%), radiographers (41.3%) and radiology nurses (12%) from the two facilities who met the inclusion criteria. Data was collected via two structured questionnaires. The collected data was entered in SPSS and analyzed for prevalence and prevalence odds. Conclusions on adequacy of practice and the factors affecting the ability of radiology departments to adequately manage cardiopulmonary events were drawn from the data collected. Results: The findings revealed that 50(66.7%) of the respondents were female, 54(72%) were aged between 20 to 35 years. Thirty-one (41.3%) of the respondents were radiographers and twenty-six (34.7%) were radiology residents. Majority of the respondents felt that life support training was relevant in their field of practice with 73(97.3%) for basic life support and 67(89.3%) for advanced cardiovascular life support training. 47(62.7%) of respondents reported having witnessed a patient go into cardiac or respiratory arrest in a radiology department with CPR being initiated in 42(89.3%) of the cases and achieving return of spontaneous circulation (ROSC) in 27(64.3%) of the attempts. An automated external defibrillator or manual defibrillator was reported to have been used 10(30.3%) of the times. 50(66.7%) were familiar with the location of resuscitation equipment and drugs in the radiology department with 27(36%) of them checking the resuscitation cart before starting procedures each day. Findings showed that 51(68%), 52(69.3%) and 58(77.3%) of the respondents felt either comfortable or very comfortable in identifying signs of impending and ongoing cardiac arrest, initiating CPR and their ability to give adequate chest compressions.

Majority of the respondents 49(65.3%) and 56(74.7%) did not feel comfortable using an Automated External Defibrillator (AED) and manual defibrillator respectively. 36(48%) were not comfortable identifying emergency cardiac rhythms while 39(52%) were not comfortable being team leader during resuscitation. The group had an average knowledge level of 51.6% and 46.1% for BLS and ACLS guidelines respectively. Only 20(27%) of the respondents had good overall knowledge on BLS and ACLS guidelines. Majority had been exposed to BLS (85.3%) and ACLS (62.7%) training at least one but recertification rates were low with only 21(32.8%) and 13(27.7%) of the respondents having valid BLS and ACLS certification at the time of the study. Gender (df =1, p =0.035), cadre of the respondent (df =3, p =0.009 and having ACLS certification (df =1, p<0.001) were shown to be significantly associated with BLS certification while gender (df =1, p =0.018), cadre of the respondent (df =3, p<0.001), having BLS certification (df =1, p<0.001) and believe that ACLS is relevant in the field of practice (df =1, p =0.003) were significantly associated with ACLS certification. Age of the respondent (df =2, p=0.019) and cadre of the respondent (df =2, p =0.043) were significantly associated with good knowledge on BLS and ACLS guidelines. KNH Siemens CT room had 31.8% of items in the airway and breathing checklist, 28.6% of the items in the circulation checklist and 50% items in the drugs checklist. The IR suite had 68.2% of items in the airway and breathing checklist, 57.1% of the items in the circulation checklist and 25% of items in the drugs checklist. The MRI room and Neusoft CT room had 40.9% and 36.4% of items in the airway and breathing checklist, 35.7% and 21.4% of the items in the circulation checklist respectively and 37.5% each for items in the drugs checklist. UoN-DDIRM did not have an emergency trolley or tray at the time of the study which was the case since the department stopped offering fluoroscopy services. Conclusion: In this study we were able to conclude that CPA does occur in our radiology departments and resuscitation saves lives. Despite a belief that training is relevant and a good attitude towards the same amongst the respondents, the majority did not have valid certification leading to a knowledge gap on the current BLS/ACLS guidelines. There was a discrepancy between the knowledge levels and the respondents' confidence levels in their own ability to manage CPA. The departments were found not to be adequately equipped with the required items for the practice of the resuscitation guidelines.