ACLS: Rapid Review and Case Scenarios, 4th ed. - book reviews

Journal of Family Practice, April, 1997 by John W. Bachman

Ken Grauer and Daniel Cavallaro. Mosby Lifeline, St Louis, Mo, 1996, 370 pp, $19.95 ISBN 0-8151-3623-4.

Sudden death remains the leading cause of death in middle-aged men. For one in three people, the first symptom of cardiovascular disease is sudden death. The outcome for cardiac arrest depends on rapid application of basic life support, rapid defibrillation, and rapid advanced cardiac life support (ACLS). Primary care physicians encounter cardiac arrests primarily in the hospital, emergency department, and at the scene of an arrest in the community. Most experts would agree that ACLS is best administered at the scene of the arrest. It is disconcerting that a study in rural Wisconsin showed that 22% of physicians could not identify coarse ventricular fibrination. (1)

Resuscitation is a team effort. Guidelines have been standardized by the American Heart Association in an effort to have members of the team operate efficiently and competently to maximize the success of the resuscitation. Certification by the American Heart Association requires course work and the testing of competency of those people involved in resuscitation. Between 1986 and 1992, more than 400,000 ACLS manuals and 46,000 instructor manuals were distributed. (2)

ACLS: Rapid Review and Case Scenarios by Grauer and Cavallaro is a 370-page paperback book to complement the materials used in the ACLS course, especially its textbook. It is divided into four chapters: Overall Approach to Management of Cardiopulmonary Arrest: Algorithms for Treatment; Essential Drugs and Treatment Modalities; Key Clinical Issues in ACLS/Airway; and Putting It All Together: Practice Code Scenarios for MEGA Code.

The strongest portion of the book is the last chapter, which consists of five cases in which a clinician is presented with an emergency. The readers are given a situation and asked, "What do you do?" Readers are allowed to test their competency. Teaching points are made at the end of each case. It is simply superb. Any clinician who sees this book should review this chapter's 68 pages of tracings and notes.

The other three chapters contain the basic information for ACLS knowledge. It is delivered in a straightforward manner. The materials are detailed, accurate, and reasonable. The details are delivered in the text, with points emphasized in boxes. In contrast to the last chapter, it is a series of facts delivered in a textbook fashion. As I read it, I wished that the authors would present a situation and challenge the reader to solve the problem and then give the details. This style would make the material more of a complement to the basic ACLS book. As it is, the details and facts are similar to those in the ACLS textbook. If one puts forth the effort, one can learn the basics from either book.

Features that could be enhanced in this book include better selection of pictures (some pictures seemed out of place and others not useful, such as the picture of the lifting of the epiglottis with the straight blade, which looked to me like an out-of-focus abstract painting) and the need for newer and better acronyms. If I were to rearrange the book I would put airway management toward the front, because of its extreme importance (oxygen is the best drug in resuscitation) and the numerous errors that occur with airway management in the emergency setting.

In summary, the fourth edition of the book is a well-defined complement to the ACLS course. Readers who deal with resuscitation would benefit most from reading the cases. Family Practice residency programs might use the last chapter to emphasize crucial aspects of resuscitation. Instructors of ACLS courses would find it a reasonable addition to their library. I am putting my book in our library for clinician colleagues. It is the type of book that should be shared.

Resuscitation teaching technique is unchanged since its inception. The technique relies on taking a course, memorization of materials, and testing. Are there better methods? Data indicate we need to find better teaching methods. A recent study at Wake Medical Center in Raleigh, North Carolina, (3) showed noncompliance with ACLS guidelines in about one third of patients treated by intensive care unit nurses and medical residents. No correlation was found between ACLS certification and guidelines compliance. With the advent of the computer and access to the Web, perhaps better methods of teaching and aids to retention may be found. Many physicians encounter an arrest rarely, and simulations may be an answer. To look at that possibility, the reader is encouraged to view a Pediatric Advanced Life Support site: http://www.embbs.com/pals/pals. html. The two cases presented at this site show the perceptive reader the start of a better way. Otherwise, read Grauer and Cavallaro's last chapter. A life may depend on it.

John W. Bachman, MD Mayo Clinic and Mayo Foundation Rochester, Minnesota

REFERENCES

(1.) Birnbaum ML, Kuska BM, Stone HL, Robinson NE. Need for advanced cardiac life-support training in rural, community hospitals. Crit Care Med 1994; 22:735-40.