Trends Over Time in Drug Administration During Adult In-Hospital Cardiac Arrest*

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achieved ROSC and those who did not, and stratified this analysis by age, gender and race. Methods: We included adult IHCA cases in GWTG-R from 2001-2017, excluding data from a given hospital and year if fewer than 5 eligible arrests were recorded. A nonparametric test for trend was done to evaluate median CPR duration over time in those with and without ROSC, in all patients and in groups stratified by age (<60, 61-80 and >80 years), gender, and race (white and black). Linear regression was done to evaluate the amount of change per year. Association with survival was tested using Pearsons correlation. Results: Of 359,107 IHCA events, 31,189 were excluded, leaving 327,918 for analysis. Over time, there was a significant increase in median CPR duration in patients who did not achieve ROSC, and a decrease in those who did attain ROSC.(Fig.) These trends persisted when stratified by gender, race and age. Each year was associated with a decrease in median CPR duration of 0.37 min (95% CI -0.41 to -0.33 min) in those with ROSC and an increase of 0.29 min (95% CI 0.25 to 0.33 min) in those without. There was a small but significant correlation between median CPR duration in those without ROSC and adjusted survival by hospital over time (r=0.224, p<0.0001). Conclusions: In the GWTG-R registry, median duration of CPR is decreasing over time in patients achieving ROSC, but increasing in those not achieving ROSC. The increasing trend in CPR duration in those without ROSC correlates positively with the trend in survival. Whether the increase in median CPR duration in those without ROSC is contributing causally to improvements in survival warrants further study.

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Intravenous Drug Administration During Out-Of-Hospital Cardiac Arrest: A Randomized Trial

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2010.01.008 ◽

2010 ◽

Vol 38 (4) ◽

pp. 557

Author(s):

Stacy Trent

Keyword(s):

Cardiac Arrest ◽

Randomized Trial ◽

Drug Administration ◽

Intravenous Drug ◽

Hospital Cardiac Arrest

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Reply to: Over time, differences in survival and favorable neurologic outcomes between conventional and compression-only cardiopulmonary resuscitation have been gradually reduced in pediatric out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2017.12.023 ◽

2018 ◽

Vol 124 ◽

pp. e9-e10

Author(s):

Yoshikazu Goto ◽

Akira Funada ◽

Yumiko Goto

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurologic Outcomes ◽

Hospital Cardiac Arrest ◽

Over Time

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Abstract 11817: The Effect of Time to Treatment With Antiarrhythmic Drugs on Return of Spontaneous Circulation in Shock Refractory Out-of-Hospital Cardiac Arrest: A Secondary Analysis of the ALPS Randomized Controlled Trial

Circulation ◽

10.1161/circ.144.suppl_2.11817 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Mahbod Rahimi ◽

Paul Dorian ◽

Sheldon Cheskes ◽

Gerald Lebovic ◽

Steve Lin

Keyword(s):

Cardiac Arrest ◽

Drug Administration ◽

Controlled Trial ◽

Group Versus ◽

Study Drug ◽

Spontaneous Circulation ◽

Study Drug Administration ◽

Time To Treatment ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

Purpose: The effects of amiodarone and lidocaine on the return of spontaneous circulation (ROSC), relative to time to treatment in out of hospital cardiac arrest (OHCA) patients is unknown. We conducted a post-hoc analysis of the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo (ROC ALPS) randomized trial examining the association of time to treatment with ROSC at emergency department (ED) arrival. Method: In the ROC ALPS trial, adults with non-traumatic OHCA with initial VF/pVT after ≥ 1 shock were randomized to receive amiodarone, lidocaine or placebo. We used logistic regression to examine the association of time to treatment (911 call to study drug administration interval) with ROSC at ED arrival. Results: Overall, 1112 (36.7%) patients had ROSC at ED arrival. Time to treatment data were available for 2994 (99%) of the patients. The proportion of patients with ROSC at ED arrival decreased as time to drug administration increased, in amiodarone (OR 0.92, 95% CI 0.90-0.94 per min increase), lidocaine (OR 0.95, 95% CI: 0.93-0.96) and placebo (OR 0.95, 95% CI: 0.93-0.96) arms. The odds of ROSC at ED in the amiodarone group (versus placebo) changed in relation to the time of drug administration (OR 0.96, 95% CI: 0.93-0.99). With short times to drug administration, ROSC was higher in amiodarone versus placebo recipients, whereas ROSC was higher with placebo at later times. Comparing lidocaine to placebo, ROSC rate increased at all times (OR 1.29, 95% CI: 1.07-1.59); there was no time to drug administration effect (OR 1.00, 95% CI: 0.97-1.03). Among all patients, survival at hospital discharge was 21.0%, 24.4%, and 23.7% for placebo, amiodarone and lidocaine respectively. Conclusion: Amiodarone’s efficacy in restoring ROSC declined with longer duration of arrest, potentially due to its adverse hemodynamic effects. Overall, amiodarone and lidocaine had similar effects on mortality; in this study, ROSC at ED arrival trend did not reflect the overall survival rate

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One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest

BMJ Open ◽

10.1136/bmjopen-2019-029756 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029756 ◽

Cited By ~ 1

Author(s):

Adam Viktorisson ◽

Katharina S Sunnerhagen ◽

Dongni Johansson ◽

Johan Herlitz ◽

Åsa Axelsson

Keyword(s):

Cardiac Arrest ◽

Psychological Distress ◽

Longitudinal Study ◽

Cerebral Performance Category ◽

Young Age ◽

Poor Health ◽

Anxiety And Depression ◽

Self Assessed Health ◽

Hospital Cardiac Arrest ◽

Over Time

ObjectivesFew studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression, self-assessed health and predictors of these outcomes in survivors of OHCA, 3 and 12 months after resuscitation.MethodsRecruitment took place from 2008 to 2011 and survivors of OHCA were identified through the national Swedish Cardiopulmonary Resuscitation Registry. Inclusion criteria were age ≥18 years, survival ≥12 months and a Cerebral Performance Category score ≤2. Questionnaires containing the Hospital Anxiety and Depression Scale and European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) were administered at 3 and 12 months after the OHCA. Participants were also asked to report treatment-requiring comorbidities.ResultsOf 298 survivors, 85 (29%) were eligible for this study and 74 (25%) responded. Clinically relevant anxiety was reported by 22 survivors at 3 months and by 17 at 12 months, while clinical depression was reported by 10 at 3 months and 4 at 12 months. The mean EQ-5D-3L index value increased from 0.82 (±0.26) to 0.88 (±0.15) over time. There were significantly less symptoms of psychological distress (p=0.01) and better self-assessed health (p=0.003) at 12 months. Treatment-requiring comorbidity predicted anxiety (OR 4.07, p=0.04), while being female and young age predicted poor health (OR 6.33, p=0.04; OR 0.91, p=0.002) at 3 months. At 12 months, being female was linked to anxiety (OR 9.23, p=0.01) and depression (OR 14.78, p=0.002), while young age predicted poor health (OR 0.93, p=0.003).ConclusionThe level of psychological distress and self-assessed health improves among survivors of OHCA between 3 and 12 months after resuscitation. Higher levels of psychological distress can be expected among female survivors and those with comorbidity, while survivors of young age and who are female are at greater risk of poor health.

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Intraosseous Drug Administration is Associated with Lower Survival in Out of Hospital Cardiac Arrest

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2020.07.053 ◽

2020 ◽

Vol 59 (5) ◽

pp. 755

Author(s):

J. Miller ◽

M. Hamam ◽

J. France ◽

R. Otero ◽

R. Swor ◽

...

Keyword(s):

Cardiac Arrest ◽

Drug Administration ◽

Lower Survival ◽

Hospital Cardiac Arrest

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Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.006514 ◽

2020 ◽

Vol 13 (9) ◽

Author(s):

Abdul H. Qazi ◽

Paul S. Chan ◽

Yunshu Zhou ◽

Mary Vaughan-Sarrazin ◽

Saket Girotra ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

Baseline Period ◽

Hospital Performance ◽

Hierarchical Regression ◽

Similar Proportion ◽

Large Improvement ◽

Hospital Cardiac Arrest ◽

Over Time

Background: A hospital’s risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time. Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines–Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012–2013) and two follow-up periods (2014–2015 and 2016–2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals’ at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline. Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.

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