Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry

Objective To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital.Design Retrospective c...

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Published in:BMJ (Online) 2016-04, Vol.353, p.i1653-i1653
Main Authors: Bradley, Steven M, Liu, Wenhui, Chan, Paul S, Nallamothu, Brahmajee K, Grunwald, Gary K, Self, Alyssa, Sasson, Comilla, Varosy, Paul D, Anderson, Monique L, Schneider, Preston M, Ho, P Michael
Format: Article
Language:English
Subjects:
Aged
Cardiac arrest
Cardiac arrhythmia
Clinical outcomes
Data collection
Electric Countershock - statistics & numerical data
Female
Heart Arrest - therapy
Hospitals
Humans
Male
Medical records
Middle Aged
Models, Statistical
Outcome Assessment (Health Care)
Patients
Quality improvement
Retrospective Studies
Statistics, Nonparametric
Survival Analysis
Tachycardia, Ventricular - therapy
Time Factors
United States
Ventricular Fibrillation - therapy
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cited_by cdi_FETCH-LOGICAL-b432t-783c978e482bca88818087af6350836771067b3a634132bf878703974e72cb623
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container_title BMJ (Online)
container_volume 353
creator Bradley, Steven M
Liu, Wenhui
Chan, Paul S
Nallamothu, Brahmajee K
Grunwald, Gary K
Self, Alyssa
Sasson, Comilla
Varosy, Paul D
Anderson, Monique L
Schneider, Preston M
Ho, P Michael
description Objective To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital.Design Retrospective cohort studySetting 172 hospitals in the United States participating in the Get With The Guidelines-Resuscitation registry, 2004-12.Participants Adults who received a second defibrillation attempt for persistent VT/VF arrest within three minutes of a first attempt.Interventions Second defibrillation attempts categorized as early (time interval of up to and including one minute between first and second defibrillation attempts) or deferred (time interval of more than one minute between first and second defibrillation attempts).Main outcome measure Survival to hospital discharge.Results Among 2733 patients with persistent VT/VF after the first defibrillation attempt, 1121 (41%) received a deferred second attempt. Deferred second defibrillation for persistent VT/VF increased from 26% in 2004 to 57% in 2012 (P
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Deferred second defibrillation for persistent VT/VF increased from 26% in 2004 to 57% in 2012 (P&lt;0.001 for trend). Compared with early second defibrillation, unadjusted patient outcomes were significantly worse with deferred second defibrillation (57.4% v 62.5% for return of spontaneous circulation, 38.4% v 43.6% for survival to 24 hours, and 24.7% v 30.8% for survival to hospital discharge; P&lt;0.01 for all comparisons). After risk adjustment, deferred second defibrillation was not associated with survival to hospital discharge (propensity weighting adjusted risk ratio 0.89, 95% confidence interval 0.78 to 1.01; P=0.08; hierarchical regression adjusted 0.92, 0.83 to 1.02; P=0.1).Conclusions Since 2004, the use of deferred second defibrillation for persistent VT/VF in hospital has doubled. Deferred second defibrillation was not associated with improved survival.</description><identifier>ISSN: 1756-1833</identifier><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.i1653</identifier><identifier>PMID: 27052620</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Aged ; Cardiac arrest ; Cardiac arrhythmia ; Clinical outcomes ; Data collection ; Electric Countershock - statistics &amp; numerical data ; Female ; Heart Arrest - therapy ; Hospitals ; Humans ; Male ; Medical records ; Middle Aged ; Models, Statistical ; Outcome Assessment (Health Care) ; Patients ; Quality improvement ; Retrospective Studies ; Statistics, Nonparametric ; Survival Analysis ; Tachycardia, Ventricular - therapy ; Time Factors ; United States ; Ventricular Fibrillation - therapy</subject><ispartof>BMJ (Online), 2016-04, Vol.353, p.i1653-i1653</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright BMJ Publishing Group LTD Apr 6, 2016</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2016 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b432t-783c978e482bca88818087af6350836771067b3a634132bf878703974e72cb623</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/353/bmj.i1653.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/353/bmj.i1653.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,780,784,885,3193,27923,27924,77465,77466</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27052620$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bradley, Steven M</creatorcontrib><creatorcontrib>Liu, Wenhui</creatorcontrib><creatorcontrib>Chan, Paul S</creatorcontrib><creatorcontrib>Nallamothu, Brahmajee K</creatorcontrib><creatorcontrib>Grunwald, Gary K</creatorcontrib><creatorcontrib>Self, Alyssa</creatorcontrib><creatorcontrib>Sasson, Comilla</creatorcontrib><creatorcontrib>Varosy, Paul D</creatorcontrib><creatorcontrib>Anderson, Monique L</creatorcontrib><creatorcontrib>Schneider, Preston M</creatorcontrib><creatorcontrib>Ho, P Michael</creatorcontrib><creatorcontrib>American Heart Association’s Get With The Guidelines-Resuscitation Investigators</creatorcontrib><title>Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital.Design Retrospective cohort studySetting 172 hospitals in the United States participating in the Get With The Guidelines-Resuscitation registry, 2004-12.Participants Adults who received a second defibrillation attempt for persistent VT/VF arrest within three minutes of a first attempt.Interventions Second defibrillation attempts categorized as early (time interval of up to and including one minute between first and second defibrillation attempts) or deferred (time interval of more than one minute between first and second defibrillation attempts).Main outcome measure Survival to hospital discharge.Results Among 2733 patients with persistent VT/VF after the first defibrillation attempt, 1121 (41%) received a deferred second attempt. Deferred second defibrillation for persistent VT/VF increased from 26% in 2004 to 57% in 2012 (P&lt;0.001 for trend). Compared with early second defibrillation, unadjusted patient outcomes were significantly worse with deferred second defibrillation (57.4% v 62.5% for return of spontaneous circulation, 38.4% v 43.6% for survival to 24 hours, and 24.7% v 30.8% for survival to hospital discharge; P&lt;0.01 for all comparisons). After risk adjustment, deferred second defibrillation was not associated with survival to hospital discharge (propensity weighting adjusted risk ratio 0.89, 95% confidence interval 0.78 to 1.01; P=0.08; hierarchical regression adjusted 0.92, 0.83 to 1.02; P=0.1).Conclusions Since 2004, the use of deferred second defibrillation for persistent VT/VF in hospital has doubled. Deferred second defibrillation was not associated with improved survival.</description><subject>Aged</subject><subject>Cardiac arrest</subject><subject>Cardiac arrhythmia</subject><subject>Clinical outcomes</subject><subject>Data collection</subject><subject>Electric Countershock - statistics &amp; numerical data</subject><subject>Female</subject><subject>Heart Arrest - therapy</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patients</subject><subject>Quality improvement</subject><subject>Retrospective Studies</subject><subject>Statistics, Nonparametric</subject><subject>Survival Analysis</subject><subject>Tachycardia, Ventricular - therapy</subject><subject>Time Factors</subject><subject>United States</subject><subject>Ventricular Fibrillation - therapy</subject><issn>1756-1833</issn><issn>0959-8138</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><recordid>eNp1kV9rFDEUxYMottQ--AUkoA_6MDV_dpKMDwWpugoFQSo-hkzmTucuM5M1ySzsN_HjmnZrqYJPScgv556cQ8hzzs44l-ptO23OkKtaPiLHXNeq4kbKxw_2R-Q0pQ1jTEhtGlU_JUdCs1oowY7Jrw_QYxtxHF3GMNOME1CcM8SdGxN1c0fDkn2YINHQU-9ih85TFyOkXEA6hLTF7MZ3NEKO5QA-4w6oD0OImaa8dHvaxzDRNWT6A_NArwag6wU7GHGGVH2DtCRfNG4NRLjGlOP-GXnSFwdwereekO-fPl5dfK4uv66_XLy_rNqVFLnSRvpGG1gZ0XpnjOGGGe16JWtmpNKaM6Vb6ZRccSna3mijmWz0CrTwrRLyhJwfdLdLO0HnYc7RjXYbcXJxb4ND-_fNjIO9DjtbJspasCLw-k4ghp9LScVOmDyUQGcIS7Jc68aUsU1T0Jf_oJuwxLl8r1CG15o3ShXqzYHyJc4Uob83w5m9qdyWyu1t5YV98dD9Pfmn4AK8OgA3b_6v8xsKLLWD</recordid><startdate>20160406</startdate><enddate>20160406</enddate><creator>Bradley, Steven M</creator><creator>Liu, Wenhui</creator><creator>Chan, Paul S</creator><creator>Nallamothu, Brahmajee K</creator><creator>Grunwald, Gary K</creator><creator>Self, Alyssa</creator><creator>Sasson, Comilla</creator><creator>Varosy, Paul D</creator><creator>Anderson, Monique L</creator><creator>Schneider, Preston M</creator><creator>Ho, P Michael</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160406</creationdate><title>Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry</title><author>Bradley, Steven M ; 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Deferred second defibrillation for persistent VT/VF increased from 26% in 2004 to 57% in 2012 (P&lt;0.001 for trend). Compared with early second defibrillation, unadjusted patient outcomes were significantly worse with deferred second defibrillation (57.4% v 62.5% for return of spontaneous circulation, 38.4% v 43.6% for survival to 24 hours, and 24.7% v 30.8% for survival to hospital discharge; P&lt;0.01 for all comparisons). After risk adjustment, deferred second defibrillation was not associated with survival to hospital discharge (propensity weighting adjusted risk ratio 0.89, 95% confidence interval 0.78 to 1.01; P=0.08; hierarchical regression adjusted 0.92, 0.83 to 1.02; P=0.1).Conclusions Since 2004, the use of deferred second defibrillation for persistent VT/VF in hospital has doubled. Deferred second defibrillation was not associated with improved survival.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>27052620</pmid><doi>10.1136/bmj.i1653</doi><oa>free_for_read</oa></addata></record>
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source JSTOR Archival Journals; BMJ Journals
subjects Aged
Cardiac arrest
Cardiac arrhythmia
Clinical outcomes
Data collection
Electric Countershock - statistics & numerical data
Female
Heart Arrest - therapy
Hospitals
Humans
Male
Medical records
Middle Aged
Models, Statistical
Outcome Assessment (Health Care)
Patients
Quality improvement
Retrospective Studies
Statistics, Nonparametric
Survival Analysis
Tachycardia, Ventricular - therapy
Time Factors
United States
Ventricular Fibrillation - therapy
title Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry
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