Association of Hospital-Level Acute Resuscitation and Postresuscitation Survival With Overall Risk-Standardized Survival to Discharge for In-Hospital Cardiac Arrest

Girotra, Saket; Nallamothu, Brahmajee K.; Tang, Yuanyuan; Chan, Paul S.

doi:10.1001/jamanetworkopen.2020.10403

Cited by 31 publications

(30 citation statements)

References 35 publications

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“…The cause of this finding is still unclear, although variation in outcomes after IHCA has been well-described even prior to COVID-19 and is only partially explained by patient-level factors: differences in centre-level resuscitation practices, withdrawal of life-sustaining measures, and post-IHCA care likely contribute. 27 , 28 , 29 Additional research is needed to investigate the patient and hospital-level factors that contribute to the heterogeneity in IHCA outcomes described in our cohort.…”

Section: Discussionmentioning

confidence: 99%

In-hospital cardiac arrest in patients with coronavirus 2019

Mitchell

Yuriditsky²,

Johnson

et al. 2021

Resuscitation

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Section: Discussionmentioning

confidence: 99%

In-hospital cardiac arrest in patients with coronavirus 2019

Mitchell

Yuriditsky²,

Johnson

et al. 2021

Resuscitation

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“…Nearly 300 000 patients have an in-hospital cardiac arrest in the United States each year, 1 and about 25% survive to discharge. 2 In addition to prompt cardiopulmonary resuscitation, the immediate treatment of in-hospital cardiac arrest is dictated by the cardiac arrest rhythm. 3 In patients with a non-shockable rhythm of asystole or pulseless electrical activity, guidelines including adult cardiac life support protocols recommend epinephrine (adrenaline) every three to five minutes.…”

Section: Introductionmentioning

confidence: 99%

Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis

Evans

Mohr

Nassar

et al. 2021

BMJ

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Objective To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. Design Propensity matched analysis. Setting 2000-18 data from 497 hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation registry. Participants Adults aged 18 and older with an index in-hospital cardiac arrest due to an initial shockable rhythm treated with defibrillation. Interventions Administration of epinephrine before first defibrillation. Main outcome measures Survival to discharge; favorable neurological survival, defined as survival to discharge with none, mild, or moderate neurological disability measured using cerebral performance category scores; and survival after acute resuscitation (that is, return of spontaneous circulation for >20 minutes). A time dependent, propensity matched analysis was performed to adjust for confounding due to indication and evaluate the independent association of epinephrine before defibrillation with study outcomes. Results Among 34 820 patients with an initial shockable rhythm, 9630 (27.6%) were treated with epinephrine before defibrillation, contrary to current guidelines. In comparison with participants treated with defibrillation first, participants receiving epinephrine first were less likely to have a history of myocardial infarction or heart failure, but more likely to have renal failure, sepsis, pneumonia, and receive mechanical ventilation before in-hospital cardiac arrest (P<0.0001 for all). Treatment with epinephrine before defibrillation was strongly associated with delayed defibrillation (median 3 minutes v 0 minutes). In propensity matched analysis (9011 matched pairs), epinephrine before defibrillation was associated with lower odds of survival to discharge (25.2% v 29.9%; adjusted odds ratio 0.81, 95% confidence interval 0.74 to 0.88; P<0.001), favorable neurological survival (18.6% v 21.4%; 0.85, 0.76 to 0.92; P<0.001), and survival after acute resuscitation (64.4% v 69.4%; 0.76, 0.70 to 0.83; P<0.001). The above findings were consistent in a range of sensitivity analyses, including matching according to defibrillation time. Conclusions Contrary to current guidelines that prioritize immediate defibrillation for in-hospital cardiac arrest due to a shockable rhythm, more than one in four patients are treated with epinephrine before defibrillation, which is associated with worse survival.

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“…1,2 Previous studies have shown substantial variation in outcomes after IHCA across hospitals in the United States, including return of spontaneous circulation (ROSC) and survival to hospital discharge. [3][4][5][6][7][8][9][10][11][12][13][14] Moreover, hospitals vary in their ability to improve outcomes over time. 3,5 Hospital-level variation in…”

mentioning

confidence: 99%

“…outcomes may reflect differences in hospital characteristics, as well as resuscitation care and quality-improvement initiatives. 3,7,10,14,15 However, it remains unclear to what extent patient characteristics may explain potential variations in outcomes. Additionally, while hospital-level variation in resuscitation care strategies has been identified in Denmark, [16][17][18] variation in outcomes remain to be explored.…”

mentioning

confidence: 99%

Hospital‐level variation in outcomes after in‐hospital cardiac arrest in Denmark

Stanković

Andersen

Granfeldt

et al. 2021

Acta Anaesthesiol Scand

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In-hospital cardiac arrest (IHCA) is associated with significant mortality and morbidity. 1,2 Previous studies have shown substantial variation in outcomes after IHCA across hospitals in the United States, including return of spontaneous circulation (ROSC) and survival to hospital discharge. [3][4][5][6][7][8][9][10][11][12][13][14] Moreover, hospitals vary in their ability to improve outcomes over time. 3,5 Hospital-level variation in

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Association of Hospital-Level Acute Resuscitation and Postresuscitation Survival With Overall Risk-Standardized Survival to Discharge for In-Hospital Cardiac Arrest

Cited by 31 publications

References 35 publications

In-hospital cardiac arrest in patients with coronavirus 2019

In-hospital cardiac arrest in patients with coronavirus 2019

Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis

Hospital‐level variation in outcomes after in‐hospital cardiac arrest in Denmark

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