Abstract 33: Impact of Delayed Time to Defibrillation on Neurological and Functional Status Among Survivors of In-Hospital Cardiac Arrest
Background: Expert guidelines advocate defibrillation within 2 minutes of an in-hospital cardiac arrest due to ventricular arrhythmias. However, the impact of delayed defibrillation on neurological and functional status at discharge among survivors is unknown.
Methods: We identified 6,744 patients with cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals within the National Registry of Cardiopulmonary Resuscitation. Using multivariable logistic regression that adjusted for demographics, clinical variables, hospital site, hospital-level variables (hospital size, monitored bed or intensive care status), and admitting diagnoses, we examined the association between delayed defibrillation (>2 minutes) and neurological and functional status at discharge using the previously developed Cerebral and Overall Performance Categories. Performance categories were dichotomized as no major disability vs. major disability and/or vegetative state.
Results: The median time to defibrillation was 1 minute (interquartile range:< 1 to 3 minutes), with delayed defibrillation found in 2,000 (29.7%) patients. Overall, 2,311 (34.3%) patients survived to hospital discharge [n=1,863 (39.3%) for prompt defibrillation; n=448 (n=22.4%) for delayed defibrillation]. Among those surviving to discharge, delayed defibrillation was associated with a lower likelihood of no major disability in neurological status (adjusted OR of 0.73; 95% CI: 0.57 to 0.94; p=0.01) and functional status (adjusted OR of 0.73; 95% CI: 0.55 to 0.96; p=0.02).
Conclusion: Delayed defibrillation is associated with worse neurological and functional status among survivors of in-hospital cardiac arrests. Minimizing time to defibrillation represents a major opportunity to improve neurological and functional status in these high-risk patients.