Aim Advanced Cardiac Life Support (ACLS) algorithms are the default standard of care for in-hospital cardiac arrest (IHCA) management. However, adherence to published guidelines is relatively poor. The records of 149 patients who experienced IHCA were examined to begin to understand the association between overall adherence to ACLS protocols and successful return of spontaneous circulation (ROSC). Methods A retrospective chart review of medical records and code team worksheets was conducted for 75 patients who had ROSC after an IHCA event (SE group) and 74 who did not survive an IHCA event (DNS group). Protocol adherence was assessed using a detailed checklist based on the 2005 ACLS Update protocols. Several additional patient characteristics and circumstances were also examined as potential predictors of ROSC. Results In unadjusted analyses, the percentage of correct steps performed was positively correlated with ROSC from an IHCA (p <0.01), and the number of errors of commission and omission were both negatively correlated with ROSC from an IHCA (p <0.01). In multivariable models, the percentage of correct steps performed and the number of errors of commission and omission remained significantly predictive of ROSC (p<0.01 and p<0.0001, respectively) even after accounting for confounders such as the difference in age and location of the IHCAs. Conclusions Our results show that adherence to ACLS protocols throughout an event is correlated with increased ROSC in the setting of cardiac arrest. Furthermore, the results suggest that, in addition to correct actions, both wrong actions and omissions of indicated actions lead to decreased ROSC after IHCA.

Purpose-Females are often reported to be generally more resistant to fatigue than males for relative intensity tasks. This has been observed repeatedly for elbow flexors, whereas at the ankle sex differences appear less robust, suggesting localized rather than systemic influences. Thus, the purpose of this study was to examine sex differences in fatigue resistance at muscle groups in a single cohort and which factors, if any, predict endurance time.Methods-Thirty-two (16 female) young adults (19 to 44 yrs) performed sustained isometric contractions at 50% maximum voluntary isometric contraction to failure for elbow flexion and ankle dorsiflexion. Pain, exertion, and muscle electromyography (EMG) were assessed throughout. Selfreported baseline activity was measured using the International Physical Activity Questionnaire.Results-Females (112.3 ± 6.2 sec) were significantly more resistant to fatigue than males (80.3 ± 5.8 sec) at the elbow (p=0.001); but not at the ankle (p=0.45; 140.6 ± 10.7 vs. 129.2 ± 10.5 sec). Peak torque was greater in males than females (p < 0.0001) at the ankle (45.0 ± 1.7 vs. 30.1 ± 1.0 Nm) and the elbow (75.7 ± 3.1 vs. 34.4 ± 2.2 Nm). Peak torque was significantly related to endurance time at the elbow (R 2 = 0.30), but not at the ankle (R 2 = 0.03). Peak pain, rate of pain increase, peak exertion, EMG, and baseline physical activity did not differ between sexes.Conclusion-Sex differences in fatigue resistance are muscle group specific. Women were more fatigue-resistant at the elbow but not the ankle during a sustained isometric contraction. Further, factors which may contribute to fatigue-resistance for one muscle group (e.g. sex, peak torque) may not be critical at another.

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