Abstract 139: Retrospective Evaluation of Resuscitation Intervals and Efficacy on Mortality
Introduction: Despite many advances in cardiopulmonary resuscitation, survival rates remain low for victims of in-hospital cardiac arrest (IHCA). Delays in defibrillation have been shown to affect outcomes. Even with short delays, however, experimental models have suggested that suboptimal resuscitation can also worsen outcomes. The interaction between the delay in beginning chest compressions and the delay in defibrillation or administration of epinephrine has not been characterized for IHCA. We hypothesized that several critical time intervals (delays) in IHCA increase mortality, with the hope to identify opportunities for improved treatment.
Methods: Data were obtained from the National Registry of Cardio-Pulmonary Resuscitation (NRCPR) and analyzed using SPSS 17 (SPSS, Chicago, IL). Witnessed, index cases of cardiac arrest were included. Logistic regression was performed on survival to hospital discharge with the following covariates: arrest interval (IA), BLS interval (IB), and initial rhythm. IA was defined as the interval between the clock time recorded (CTR) for pulselessness to the CTR for the beginning of chest compressions. IB was defined as the interval between CTR for beginning of chest compressions and either the CTR for defibrillation (IBDef) or for epinephrine administration (IBEpi), whichever occurred first. Any non-zero positive intervals were considered as delays. IB values were truncated at 30 min.
Results: IA (n = 6047) ranged from 1 to 5 min (1.7 ± 0.9 min, mean ± SD), while IBDef (n = 13559) ranged from 1 to 30 min (7.0 ± 6.5) and IBEpi (n = 40842) ranged from 1 to 20 min (3.6 ± 2.9). Logistic regression shows that both IBDef (n = 855, p < 0.005) and IBEpi (n = 2470, p = 0.05) are a risk factor for mortality. In both analyses, however, IA and initial rhythm were not predictive of survival to hospital discharge.
Conclusions: Delays in defibrillation and epinephrine administration (and hence longer BLS interval) were found in IHCA and were associated with increased mortality. Future training efforts for IHCA should focus on reducing delay to defibrillation and epinephrine administration.
- © 2010 by American Heart Association, Inc.