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Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest.

Publication ,  Journal Article
Patel, KK; Spertus, JA; Khariton, Y; Tang, Y; Curtis, LH; Chan, PS; American Heart Association’s Get With the Guidelines–Resuscitation Investigators
Published in: Circulation
May 8, 2018

BACKGROUND: Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients with in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown. METHODS: We linked data from a national IHCA registry with Medicare files and identified 36 961 patients ≥65 years of age with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA caused by pulseless ventricular tachycardia or ventricular fibrillation were stratified by prompt (≤2 minutes) versus delayed (>2 minutes) defibrillation, whereas patients with IHCA caused by asystole or pulseless electric activity were stratified by prompt (≤5 minutes) versus delayed (>5 minutes) epinephrine treatment. The association between prompt treatment and long-term survival for each rhythm type was assessed with multivariable hierarchical modified Poisson regression models. RESULTS: Of 8119 patients with an IHCA caused by ventricular tachycardia or ventricular fibrillation, the rate of 1-year survival was higher in those treated with prompt defibrillation than with delayed defibrillation (25.7% [1466 of 5714] versus 15.5% [373 of 2405]; adjusted relative risk [RR], 1.49; 95% confidence interval [CI] 1.32-1.69; P<0.0001). This survival advantage persisted at 3 years (19.1% versus 11.0%; adjusted RR, 1.45; 95% CI, 1.23-1.69; P<0.0001) and at 5 years (14.7% versus 7.9%; adjusted RR, 1.50; 95% CI, 1.22-1.83; P<0.0001). Of 28 842 patients with an IHCA caused by asystole/pulseless electric activity, the rate of 1-year survival with prompt epinephrine treatment was higher than with delayed treatment (5.4% [1341 of 24 885] versus 4.3% [168 of 3957]; adjusted RR, 1.20; 95% CI, 1.02-1.41; P=0.02), but this survival benefit was no longer present at 3 years (3.5% versus 2.9%; adjusted RR, 1.17; 95% CI, 0.95-1.45; P=0.15) and at 5 years (2.3% versus 1.9%; adjusted RR, 1.18; 95% CI, 0.88-1.58; P=0.27). CONCLUSIONS: Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years. By quantifying the greater survival associated with timely defibrillation and epinephrine administration, these findings provide important insights into the durability of survival benefits for 2 process-of-care measures in current resuscitation guidelines.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

May 8, 2018

Volume

137

Issue

19

Start / End Page

2041 / 2051

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Risk Factors
  • Registries
  • Recovery of Function
  • Medicare
  • Male
  • Inpatients
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Patel, K. K., Spertus, J. A., Khariton, Y., Tang, Y., Curtis, L. H., Chan, P. S., & American Heart Association’s Get With the Guidelines–Resuscitation Investigators. (2018). Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation, 137(19), 2041–2051. https://doi.org/10.1161/CIRCULATIONAHA.117.030488
Patel, Krishna K., John A. Spertus, Yevgeniy Khariton, Yuanyuan Tang, Lesley H. Curtis, Paul S. Chan, and American Heart Association’s Get With the Guidelines–Resuscitation Investigators. “Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest.Circulation 137, no. 19 (May 8, 2018): 2041–51. https://doi.org/10.1161/CIRCULATIONAHA.117.030488.
Patel KK, Spertus JA, Khariton Y, Tang Y, Curtis LH, Chan PS, et al. Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation. 2018 May 8;137(19):2041–51.
Patel, Krishna K., et al. “Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest.Circulation, vol. 137, no. 19, May 2018, pp. 2041–51. Pubmed, doi:10.1161/CIRCULATIONAHA.117.030488.
Patel KK, Spertus JA, Khariton Y, Tang Y, Curtis LH, Chan PS, American Heart Association’s Get With the Guidelines–Resuscitation Investigators. Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation. 2018 May 8;137(19):2041–2051.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

May 8, 2018

Volume

137

Issue

19

Start / End Page

2041 / 2051

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Risk Factors
  • Registries
  • Recovery of Function
  • Medicare
  • Male
  • Inpatients