Retrospective evaluation of resuscitation medication utilization in hospitalized adult patients with cardiac arrest.
BACKGROUND
Early medication administration in cardiac arrest improves outcomes. The primary objective was to evaluate the association between epinephrine administration in in-hospital cardiac arrest (IHCA) patients with non-shockable rhythm and the patient outcomes. The secondary objective was to assess the compliance of epinephrine and amiodarone administration in accordance with the advanced cardiovascular life support (ACLS) guideline.


METHODS
IHCA patients aged 18 years or above were identified from the resuscitation registry of 2016 of two public hospitals and categorized according to their initial rhythms. For patients with non-shockable rhythms, the associations between IHCA outcomes, return of spontaneous circulation (ROSC), and survival to discharge, and the time of epinephrine administration were analyzed by logistic regression. The compliance rate of epinephrine and amiodarone administration during resuscitation to ACLS guideline were reported.


RESULTS
Among 349 patients with non-shockable rhythm, the median time to epinephrine administration was 3 min (interquartile range, 1-6 min). Early epinephrine administration (<5 min), compared with late epinephrine administration (>5 min), was significantly associated with the rate of ROSC (49.2% vs 34.9%; adjusted odds ratio, 1.630; 95% confidence interval 1.008-2.635, p = 0.046). The time to epinephrine administration (as continuous interval) was significantly associated with the rate of ROSC (p = 0.002) and survival to discharge (p = 0.029). In addition, the compliance rate of epinephrine and amiodarone administration during resuscitation were 83.6% and 33.3%, respectively.


CONCLUSION
Our study found that time of epinephrine administration was significantly associated with better results in ROSC and survival to discharge in IHCA patients with non-shockable rhythm. When we divided the IHCA patients with non-shockable rhythms into early and late administration group, early epinephrine administration was associated with significantly improved ROSC, but not survival to discharge after adjusting with potential confounding factors.
['Tenney|Justin Wade|JW|', 'Yip|Jessica Hiu Yan|JHY|', 'Lee|Roy Hong Yuen|RHY|', 'Wong|Billy Cheuk Yin|BCY|', 'Hung|Kevin Kei Ching|KKC|', 'Lam|Rex Pui Kin|RPK|', 'Wong|Daniel Kin Wa|DKW|', 'Wong|Wai Tat|WT|']
D000368:Aged D000369:Aged, 80 and over D000638:Amiodarone D016887:Cardiopulmonary Resuscitation D003326:Coronary Circulation D004837:Epinephrine D005260:Female D006323:Heart Arrest D017052:Hospital Mortality D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies
Resuscitation Cardiac arrest Epinephrine Amiodarone Emergency medicine