Abstract 18274: Comparative Effectiveness of Stacked versus Single Shock Therapy for In-Hospital Cardiac Arrest: Insights from the Get With the Guidelines-Resuscitation Registry

Background: Among patients with cardiac arrest due to ventricular tachycardia or ventricular fibrillation (VT/VF), guidelines emphasize single shock protocols to minimize interruptions in chest compressions that may impair patient outcomes. The adoption and impact of single shock protocols on survival of in-hospital VT/VF arrest is unknown. Methods: In the Get With The Guidelines - Resuscitation multicenter observational registry, we identified 4,114 adults with in-hospital cardiac arrest due to VT/VF between 2004 and 2012, an immediate post-shock rhythm of VT/VF following the initial defibrillation attempt, and a second defibrillation attempt within 3 minutes of the first shock. The time interval in minutes from the initial shock to second shock was used to define stacked shock (time interval of 0 to 1 minute) and single shock protocols (time interval of 2 to 3 minutes). We first evaluated temporal trends in the use of stacked versus single shock protocols. We then used hierarchical regression adjusting for patient arrest characteristics and comorbidities while accounting for clustered observations by hospital to determine the association between stacked versus single shocks for VT/VF and survival to discharge. For this analysis, we restricted our cohort to the 2,984 (72.5%) patients with VT/VFarrest occurring at one of 150 hospitals with the use of both stacked and single shock approaches and at least 10 events during the study period. Results: The proportion of patients receiving a single shock protocol for VT/VF following an initial defibrillation attempt doubled from 25% in 2004 to more than 50% in 2012. Compared with patients treated with stacked shocks, treatment with single shocks was associated with a lower risk-adjusted survival to discharge (odds ratio 0.81, 95% confidence interval 0.68 to 0.98, P=0.03). Conclusion: Among adults with in-hospital VT/VFarrest, use of single shocks has increased since 2004 in accordance with guideline recommendations. However, compared with stacked shocks, single shocks for VT/VF was associated with decreased odds of survival to discharge. These observational findings suggest further investigation is needed to define the optimal defibrillation strategy for management of in-hospital VT/VF arrest.

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Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.311 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Abdul H Qazi ◽

Yunshu Zhou ◽

Paul Chan ◽

Saket Girotra

Keyword(s):

Cardiac Arrest ◽

Survival Rates ◽

Baseline Period ◽

Hospital Performance ◽

Hierarchical Regression ◽

Time Intervals ◽

Hierarchical Regression Model ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( > 25 percentile points) at 26.8% and by at least 2 quartiles ( > 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

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Abstract 128: Assessing the Temporal Trend in Survival to Hospital Admission Following Out-Of-Hospital Cardiac Arrest: Analysis From a Public Access Defibrillator Registry

Circulation ◽

10.1161/circ.140.suppl_2.128 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Hannah Torney ◽

Olibhear McAlister ◽

Adam Harvey ◽

Raymond Bond ◽

Dewar Finlay ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Admission ◽

Time Of Day ◽

Public Access ◽

Patient Demographics ◽

Shockable Rhythm ◽

Post Shock ◽

Day Of The Week ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Introduction: The AHA Get With the Guidelines Resuscitation Investigators recently identified that in-hospital cardiac arrest patients admitted during nights and weekends are less likely to survive to discharge. Our analysis aimed to determine if a similar relationship applied to out-of-hospital cardiac arrest (OHCA) patients. Methods: Worldwide data collection began in Oct 2012. Users of HeartSine SAM PAD public access defibrillators submitted electronic event data (comprising time/date of event and electrocardiogram traces) and an event report form (comprising patient demographics, location of arrest and survival to hospital outcome). First shock success was defined as termination of shockable rhythm for 5 seconds post-shock. Data was analysed using R. Results: A total of 3400 OHCA cases were collected. Median (IQR) age was 63 (50, 75) and males accounted for 72.4% of the dataset. A total of 1127 first shocks were delivered, and first shock success was 87.2% (983 shocks). Survival outcomes were reported in 2942 cases, and 783 (26.6%) patients survived to hospital admission. First shock success as a response to day of the week (weekday versus weekend [12am Saturday-11.59pm Sunday]) adjusted for patient age, gender and location of arrest, was assessed and there was no association found. When the same model was fitted with survival to hospital admission as a response to day of the week, it was determined that patients are approximately 20% less likely to survive to hospital admission at the weekend (OR=0.81, 95%CI [0.68, 0.95], p=0.01). There was a negative association between survival and OHCA occurring at home (OR=0.32, 95%CI [0.10, 0.94], p=0.03) and increasing age (per 1-year increase, OR=0.99, 95%CI [0.98, 1.00], p<0.001). Adjusting the model for time of day (morning [6am-11.59am], afternoon [12pm-5.59pm], evening [6pm-11.59pm] and night [12am-5.59am]) did not highlight an association with any particular time of day. Conclusions: OHCA patients are significantly less likely to survive to hospital admission at weekends compared to weekdays. Further analysis on the availability of PADs at professional and recreational locations and availability of trained medical rescuers at the weekend versus weekdays could account for the differences observed.

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Abstract 18923: Trends in Long-term Survival After In-hospital Cardiac Arrest: Insights From Get With the Guidelines-Resuscitation®

Circulation ◽

10.1161/circ.132.suppl_3.18923 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Lauren E Thompson ◽

Paul S Chan ◽

Fengmeng Tang ◽

Brahmajee K Nallamothu ◽

Saket Girotra ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Temporal Trends ◽

Pulseless Electrical Activity ◽

Term Survival ◽

Initial Rhythm ◽

Adjusted Rate ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background: Although survival to hospital discharge after in-hospital cardiac arrest (IHCA) has improved over the last decade, it is unknown if these survival gains are sustained after hospital discharge. Accordingly, we evaluated temporal trends in 1-year survival after IHCA. Methods: We linked data from Get With The Guidelines-Resuscitation (a national IHCA registry) with Medicare files and evaluated temporal trends in 1-year survival after IHCA between 2000 and 2011, using multivariable Poisson regression models to account for patient factors, clinical factors, cardiac arrest characteristics (e.g. initial rhythm, location of arrest), and hospital site. We examined 1-year survival trends overall, and separately for shockable (ventricular fibrillation [VF] and pulseless ventricular tachycardia [VT]) and non-shockable rhythms (asystole and pulseless electrical activity [PEA]). Results: Of 45,567 patients with IHCA, the majority had a presenting rhythm of PEA (43.5%) or asystole (42.2%), and half (53.6%) occurred in an ICU. Overall 1-year survival was 9.4%, with higher survival each successive year (FIGURE). Risk-adjusted 1-year survival increased over time for all IHCA (adjusted rate ratio [RR] per year, 1.05; 95% confidence interval [CI], 1.04 to 1.06; P<0.001 for trend) and separately for VT/VF and PEA/asystole arrests (all p for trend <0.001). Compared with 2000-01, 1-year survival after IHCA in 2011 increased by 62% (adjusted RR, 1.62 [95% CI: 1.44-1.81]) (TABLE). Conclusions: Over the past decade, 1-year survival after IHCA has significantly improved each year.

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Abstract 237: Comparative Efficacy of Biphasic Waveform Defibrillation Energies for In-Hospital Cardiac Arrest: Insights from the Get With The Guidelines--Resuscitation Registry

Circulation ◽

10.1161/circ.130.suppl_2.237 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Preston M Schneider ◽

Wenhui Liu ◽

Gary K Grunwald ◽

Paul S Chan ◽

Brahmajee K Nallamothu ◽

...

Keyword(s):

Cardiac Arrest ◽

Primary Outcome ◽

Energy Levels ◽

Spontaneous Circulation ◽

Hierarchical Regression ◽

Shock Energy ◽

Biphasic Waveform ◽

Get With The Guidelines ◽

Adjusted Association ◽

Hospital Cardiac Arrest

Background: Biphasic waveforms have become the predominant choice for defibrillation of cardiac arrest due to pulseless ventricular tachycardia or ventricular fibrillation (VT/VF). However, little is known about the relative efficacy of different first shock energy levels for defibrillation of VT/VF. Methods: Within the Get With The Guidelines - Resuscitation multicenter observational registry, we identified adults who received biphasic waveform defibrillation for in-hospital cardiac arrest due to VT/VF between 2005 and 2012. Using hierarchical regression to adjust for patient arrest characteristics and comorbidities while accounting for clustered observations by hospital, we examined the risk-adjusted association between the energy level (100J, 120J, 150J, 200J, 300J, or 360J) of the first defibrillation attempt and patient outcomes. Our primary outcome was termination of VT/VF following the first shock, with secondary outcomes of return of spontaneous circulation (ROSC), 24 hour survival, and survival to discharge. Results: Among 12,417 adults suffering VT/VF arrest treated with biphasic defibrillation, the most common first shock energy was 200 J (55.5%) Compared with 200 J, defibrillation with 120 J was more likely to result in termination of VT/VF and 24 hour survival and 150J was associated with greater 24 hour survival and survival to discharge. In contrast, energies higher than 200 J showed no difference in termination of VT/VF, but were associated with lower survival (see Table). Conclusion: Among adults with in-hospital cardiac arrest due to VT/VF, defibrillation with 200 J is the most common energy used for initial defibrillation with a biphasic waveform. However, initial defibrillation with lower energy levels is associated with greater odds of VT/VF termination, 24 hour survival, and survival to discharge. Further study is needed to inform the optimal energy for initial defibrillation of cardiac arrest due to VT/VF.

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Association between resuscitation time interval at the scene and neurological outcome after out-of-hospital cardiac arrest in two Asian cities

Resuscitation ◽

10.1016/j.resuscitation.2013.10.021 ◽

2014 ◽

Vol 85 (2) ◽

pp. 203-210 ◽

Cited By ~ 29

Author(s):

Sang Do Shin ◽

Tetsuhisa Kitamura ◽

Seung Sik Hwang ◽

Kentaro Kajino ◽

Kyoung Jun Song ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Time Interval ◽

Asian Cities ◽

Hospital Cardiac Arrest

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Temporal trends in out-of-hospital cardiac arrest survival outcomes between two metropolitan communities: Seoul-Osaka resuscitation study

BMJ Open ◽

10.1136/bmjopen-2015-007626 ◽

2015 ◽

Vol 5 (6) ◽

pp. e007626-e007626 ◽

Cited By ~ 17

Author(s):

Y. S. Ro ◽

S. D. Shin ◽

T. Kitamura ◽

E. J. Lee ◽

K. Kajino ◽

...

Keyword(s):

Cardiac Arrest ◽

Temporal Trends ◽

Survival Outcomes ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

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Abstract 249: The Effect of Response Time on Out-Of-Hospital Cardiac Arrest Survival Varies by Patient Subpopulation

Circulation ◽

10.1161/circ.138.suppl_2.249 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Clara Stoesser ◽

Justin Boutilier ◽

Christopher L Sun ◽

Katie N Dainty ◽

Steve Lin ◽

...

Keyword(s):

Cardiac Arrest ◽

Regression Analysis ◽

Response Time ◽

Time Interval ◽

Probability Of Survival ◽

Subgroup Analyses ◽

Impact On Survival ◽

The Impact ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

Itroduction: Previous research has quantified the impact of EMS response time on the probability of survival from OHCA, but the impact on different subpopulations is currently unknown. Aim: To investigate how response time affects OHCA survival for different patient subpopulations. Methods: We conducted a logistic regression analysis on non-EMS witnessed OHCAs of presumed cardiac etiology from the Toronto Regional RescuNet between January 1, 2007 and December 31, 2016. We predicted survival using age, sex, public location, presenting rhythm, bystander witnessed, bystander resuscitation, and response time, defined as the time interval from 911 call to EMS arrival at the patient. We conducted subgroup analyses to quantify the effect of response time on survival for eight different subpopulations: public, private, bystander resuscitation, no bystander resuscitation, patients ≥65, patients <65, witnessed, and unwitnessed OHCA. We also quantified the effect of response time on survival for pairwise intersections of the subpopulations. We compared our results to Valenzuela et al. (1997), which suggests survival odds decrease by 10% for each minute delay in response time. Results: We identified 22,988 OHCAs. Overall, a one-minute delay in EMS response time was associated with a 13.2% reduction in the odds of survival. The reduction varied by subpopulation, ranging from a 7.2% reduction in survival odds for unwitnessed arrests to a 16.4% reduction in survival odds for arrests with bystander resuscitation. Response time had the largest impact on survival for the subpopulation of OHCAs that were both witnessed and received bystander resuscitation (17.4% reduction in survival odds). Conclusion: The effect of a one-minute delay in EMS response on the odds of survival from OHCA can be as low as a 7.2% reduction and as high as a 17.4% reduction. This variability contrasts with the currently accepted 10% rule that is assumed across the entire population.

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Abstract 252: The Association of Award Recognition From Get With the Guidelines-Resuscitation with Improved Survival Rates in In-Hospital Cardiac Arrest Events

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.252 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Kathie Thomas ◽

Art Miller ◽

Greg Poe

Keyword(s):

Cardiac Arrest ◽

Quality Improvement ◽

Survival Rate ◽

Discharge Rate ◽

Survival Rates ◽

Improvement Program ◽

Award Winning ◽

National Survival ◽

Get With The Guidelines ◽

Hospital Cardiac Arrest

Background and Objectives: It is estimated that over 200,000 adults experience in-hospital cardiac arrest each year. Overall survival to discharge has remained relatively unchanged for decades and survival rates remain at about 20% (Elenbach et al., 2009). Get With The Guidelines-Resuscitation (GWTG-R) is an in-hospital quality improvement program designed to improve adherence to evidence-based care of patients who experience an in-hospital resuscitation event. GWTG-R focuses on four achievement measures. The measures for adult patients include time to first chest compression of less than or equal to one minute, device confirmation of correct endotracheal tube placement, patients with pulseless VF/VT as the initial documented rhythm with a time to first shock of less than or equal to two minutes, and events in which patients were monitored or witnessed at the time of cardiac arrest. The objective of this abstract is to examine the association between hospital adherence to GWTG-R and in-hospital cardiac arrest survival rates. Methods: A retrospective review of adult in-hospital cardiopulmonary arrest (CPA) patients (n=1849) from 21 Michigan, Illinois, and Indiana hospitals using the GWTG-R database was conducted from January 2014 through December 2014. This study included adult CPA patients that did and did not survive to discharge. Results: The review found that hospitals that had attained 84.6% or higher thresholds in all four achievement measures for at least one year, which is award recognition status, had a significantly improved in-hospital CPA survival to discharge rate of 29.6%. Hospitals that did not obtain award status had a CPA survival to discharge rate of 24.3%. The national survival rate for in-hospital adult CPA survival to discharge is 20%. Hospitals that did not achieve award recognition status still demonstrated improvement in survival rate when compared to the national survival rate, indicating the importance of a quality improvement program such as GWTG-R. No significant difference was found between in-hospital adult CPA survival rate and race between GWTG-R award winning and non-award winning hospitals. Hospitals that earned award recognition from GWTG-R had a survival to discharge rate of 30.2% for African Americans and 29.6% for whites. Hospitals that were did not earn award recognition from GWTG-R had a survival to discharge rate of 20.0% for African Americans and 20.1% for whites. Conclusions: Survival of in-hospital adult CPA patients improved significantly when GWTG-R measures are adhered to. Survival of in-hospital adult CPA patients also improves with implementation of GWTG-R. It is crucial that hospitals collect and analyze data regarding resuscitation processes and outcomes. Quality improvement measures can then be implemented in order to assist with improving in-hospital CPA survival rates.

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