Abstract 1776: Institutional Characteristics Influence Self-Reported Time to Defibrillation in Patients with In-Hospital Cardiac Arrest Due to Ventricular Tachyarrhythmia: A National Registry of Cardiopulmonary Resuscitation Analysis
Background: Current guidelines recommend defibrillation to be performed within (<) 3 mins of identifying pulseless ventricular tachycardia and fibrillation (p-VT/VF) in order to maximize in-hospital survival. The influence of institutional characteristics like telemetry status and hospital size on time to defibrillation has not been reported.
Objective: We hypothesized that telemetry status and hospital size would be associated with the likelihood of receiving defibrillation within 3 mins for patients with in-hospital cardiac arrest due to p-VT/VF.
Methods: We used data on 4,238 adult patients with a first episode of p-VT/VF from the National Registry of Cardioplumonary Resuscitation (NRCPR), a multicenter observational registry of in-hospital cardiac arrest. We categorized patients based on their location (general medical beds without telemetry, general medical beds with telemetry and ICU beds) and hospital size (small [< 250], medium [250–500], and large [>500]). Multivariable logistic regression with GEE models was used to determine the likelihood of receiving defibrillation within 3 mins. Times to defibrillation in this model are self-reported.
Results: In the ICU 78.7% of patients were reported to have defibrillation attempted within 3 minutes compared with 62.6% in general beds with telemetry and 53.7% in general beds without telemetry (p < 0.0001). Small hospitals had reported defibrillation attempts within 3 mins less often than larger-sized hospitals (61.5% in small hospitals vs. 67.9% in medium hospitals vs. 68.0% in large hospitals, p = 0.0006). The table⇓ lists variables associated with reported attempted defibrillation within 3 mins after multivariable adjustment.
Conclusions: Institutional factors like telemetry status and hospital size are associated with self-reported time to defibrillation in patients with in-hospital cardiac arrest due to p-VT/VF. Quality improvement efforts should be targeted in these at-risk patients.