Abstract P197: Duration of Hospital Participation in Get With The Guidelines--Resuscitation and Survival of In-Hospital Cardiac Arrest

Abstract

Background. Get With the Guidelines (GWTG)-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation (NRCPR)) is a data registry and quality improvement program for in-hospital cardiac arrest (IHCA). It is unknown if duration of hospital participation in GWTG-Resuscitation is associated with IHCA outcomes. Methods. We analyzed 104,732 adult patients with IHCA from 362 hospitals participating in GWTG-Resuscitation between 2000 and 2009. The association between duration of hospital participation in GWTG-Resuscitation and patient outcomes after IHCA was determined with multiple logistic regression after adjusting for patient and hospital characteristics and secular trends by inclusion of calendar year. We also evaluated the association between duration of participation and factors previously correlated with survival after IHCA, including ECG monitored status, after-hours arrest, and time to defibrillation. All models were constructed as generalized estimating equations to account for clustering of patients at the hospital level. Results. Survival to discharge occurred in 17,646 patients (16.9%). Duration of hospital participation in GWTG-Resuscitation was weakly associated with improved IHCA outcomes (Table). Among factors correlated with IHCA survival, duration of participation was associated with time to defibrillation < 2 minutes (per year of participation, OR 1.06; 95% CI 1.03-1.09; p<0.001), but not ECG monitored status (OR 1.00; 95% CI 0.93-1.06; p=0.90) or survival of after-hours arrest (OR 1.01; 95% CI 0.99-1.03; p=0.41). Inclusion of time to defibrillation attenuated the association between duration of participation and outcomes of ventricular tachycardia or ventricular fibrillation (VT/VF) arrests. Conclusion. Duration of hospital participation in GWTG-Resuscitation is weakly associated with survival of IHCA. In VT/VF arrests, this association may be mediated by improvements in time to defibrillation. Survival by Duration of Hospital Participation in Get With the Guidelines-Resuscitation Odds-Ratio per Year of GWTG-Resuscitation Participation (95% CI) Unadjusted Model 1: Patient and Hospital Characteristics and Calendar Year Model 1 Plus ECG Monitored Model 1 Plus After-Hours Arrest Model 1 Plus Time to Defibrillation All Events Survival of event 1.06 (1.05-1.07) ‡ 1.02 (1.00-1.03) * 1.02 (1.00-1.04) * 1.02 (1.00-1.04) * N/A Survival to 24 hours 1.03 (1.02-1.04) ‡ 1.01 (0.99-1.03) 1.01 (0.99-1.03) 1.01 (0.99-1.03) Survival to discharge 1.03 (1.02-1.04) ‡ 1.02 (0.99-1.04) 1.02 (0.99-1.04) 1.02 (0.99-1.04) No major disability 1.04 (1.01-1.06) * 1.00 (0.96-1.05) 1.00 (0.96-1.05) 1.00 (0.96-1.05) VT/VF Arrest Events Survival of event 1.06 (1.04-1.08) ‡ 1.03 (1.00-1.05) * 1.03 (1.00-1.05) * 1.03 (1.00-1.05) * 1.01 (0.98-1.04) Survival to 24 hours 1.03 (1.01-1.05) † 1.01 (0.99-1.04) 1.01 (0.99-1.04) 1.01 (0.99-1.04) 1.00 (0.97-1.02) Survival to discharge 1.03 (1.01-1.05) † 1.01 (0.98-1.04) 1.01 (0.98-1.04) 1.01 (0.98-1.04) 1.00 (0.97-1.03) No major disability 1.03 (1.00-1.07) * 1.00 (0.95-1.05) 1.00 (0.95-1.05) 1.00 (0.95-1.05) 0.99 (0.94-1.04) All models were constructed as generalized estimating equations with independent correlation matrix and robust variance to account for clustering of patients at the hospital level. * p<0.05; † p<0.01; ‡ p<0.001.