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. 2016 Apr 6:353:i1653.
doi: 10.1136/bmj.i1653.

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

Steven M Bradley  1 , Wenhui Liu  2 , Paul S Chan  3 , Brahmajee K Nallamothu  4 , Gary K Grunwald  2 , Alyssa Self  5 , Comilla Sasson  6 , Paul D Varosy  7 , Monique L Anderson  8 , Preston M Schneider  9 , P Michael Ho  7 ; American Heart Association’s Get With The Guidelines-Resuscitation Investigators
Affiliations

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

Steven M Bradley et al. BMJ. .

Abstract

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 study

Setting: 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<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<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.

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Conflict of interest statement

Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow and selection of patients in study of defibrillation time intervals and outcomes of cardiac arrest in hospital
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Fig 2 Temporal trends in early (one minute or less) and deferred (more than one minute) defibrillation intervals in patients with cardiac arrest in hospital
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References

    1. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: advanced cardiovascular life support: section 2: defibrillation. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation 2000;102(Suppl):I90-4.pmid:10966666. - PubMed
    1. Yu T, Weil MH, Tang W, et al. Adverse outcomes of interrupted precordial compression during automated defibrillation. Circulation 2002;106:368-72. 10.1161/01.CIR.0000021429.22005.2E pmid:12119255. - DOI - PubMed
    1. Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance of continuous chest compressions during cardiopulmonary resuscitation: improved outcome during a simulated single lay-rescuer scenario. Circulation 2002;105:645-9. 10.1161/hc0502.102963 pmid:11827933. - DOI - PubMed
    1. Eftestøl T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation 2002;105:2270-3. 10.1161/01.CIR.0000016362.42586.FE pmid:12010909. - DOI - PubMed
    1. Berg RA, Sanders AB, Kern KB, et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 2001;104:2465-70. 10.1161/hc4501.098926 pmid:11705826. - DOI - PubMed

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