Abstract 17454: Automated External Defibrillators and Survival After In-Hospital Cardiac Arrest
Background: Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrests, but data on their effectiveness in hospitalized patients are limited.
Methods: Within the National Registry of Cardiopulmonary Resuscitation, we identified patients with cardiac arrests at 204 hospitals after the introduction of AEDs. Using multivariable hierarchical regression, we compared survival in patients in whom AEDs were used to assess and treat the initial cardiac arrest rhythm with those in whom AEDs were not used. All models adjusted for over 30 variables, including patient demographics and clinical comorbidities, initial presenting rhythm, monitoring status, time and day of arrest, and hospital characteristics.
Results: Of 11,695 patients, 9616 (82.2%) had non-shockable rhythms (asystole and pulseless electrical activity) and 2079 (17.8%) had shockable rhythms (pulseless ventricular tachycardia and ventricular fibrillation). AEDs were used in 4515 (38.6%) patients. Overall, 2117 (18.1%) patients survived to hospital discharge. In the overall cohort, AED use was associated with a 15% lower rate of in-hospital survival compared with no AED use (16.3% vs. 19.3% adjusted RR, 0.85; 95% CI, 0.78–0.92; P<0.001) (Table). Among cardiac arrests due to non-shockable rhythms, AED use was associated with a 26% lower rate of in-hospital survival (10.4% vs. 15.4% adjusted RR, 0.74; 95% CI, 0.65–0.83; P<.001). In contrast, for cardiac arrests due to shockable rhythms, AED use was not associated with in-hospital survival (38.4% vs. 39.8% adjusted RR, 1.00; 95% CI, 0.88–1.13; P=0.99). These patterns were also observed when we evaluated cardiac arrest cases occurring solely in monitored or non-monitored hospital units (<ul;2>Table<ul;0>).
Conclusions: Use of AEDs in hospitalized patients with cardiac arrest was not associated with improved survival and may be associated with harm in cardiac arrest cases due to asystole or pulseless electrical activity.
- © 2010 by American Heart Association, Inc.