Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registryBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1653 (Published 06 April 2016) Cite this as: BMJ 2016;353:i1653
- Steven M Bradley, cardiologist and researcher1 2 3,
- Wenhui Liu, analyst1 4,
- Paul S Chan, cardiologist and researcher5,
- Brahmajee K Nallamothu, interventional cardiologist and researcher6,
- Gary K Grunwald, statistician1 4,
- Alyssa Self, medical student2,
- Comilla Sasson, emergency medicine physician and researcher7,
- Paul D Varosy, cardiac electrophysiologist and researcher1 2 3,
- Monique L Anderson, cardiologist and researcher8,
- Preston M Schneider, cardiologist and researcher2 3,
- P Michael Ho, cardiologist and researcher1 2 3
- for the American Heart Association’s Get With The Guidelines-Resuscitation Investigators
- 1VA Eastern Colorado Health Care System, Denver, CO, USA
- 2University of Colorado School of Medicine, Aurora, CO, USA
- 3Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA
- 4University of Colorado School of Public Health, Aurora, CO, USA
- 5Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, MO, USA
- 6University of Michigan Medical School, Ann Arbor, MI, USA
- 7American Heart Association, Dallas, TX, USA
- 8Duke Clinical Research Institute, Durham, NC, USA
- Correspondence to: S M Bradley, VA Eastern Colorado Health Care System, Department of Veterans Affairs, 1055 Clermont Street (111B), Denver, CO 80220-3808, USA
- Accepted 7 March 2016
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.
Get With The Guidelines-Resuscitation Adult Task Force
SMB, PSC, Saket Girotra (University of Iowa Carver College of Medicine); Michael W Donnino (Beth Israel Deaconess Medical Center); Dana P Edelson (University of Chicago); Robert T Faillace (Geisinger Healthcare System); Romergryko Geocadin (Johns Hopkins University School of Medicine); Raina Merchant (University of Pennsylvania School of Medicine); Vincent N Mosesso (University of Pittsburgh School of Medicine); Joseph P Ornato and Mary Ann Peberdy (Virginia Commonwealth University).
Contributors: SMB was responsible for conception, design, analysis, data interpretation, and manuscript writing. WL and GKG analyzed and interpreted data and wrote the manuscript. PSC, BKN, and PMH designed the study, interpreted data, and wrote the manuscript. AS, CS, PDV, MLA, and PMS interpreted data and wrote the manuscript. SMB had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and is guarantor.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. SMB is supported by a career development award (HSR&D-CDA2 10-199) from VA Health Services Research and Development. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
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.
Ethical approval: This study was approved by the Colorado multiple institutional review board.
Data sharing: No additional data available. Requests for GWTG-R data are managed by the American Heart Association (http://www.heart.org/HEARTORG/HealthcareResearch/Healthcare-Research_UCM_001093_SubHomePage.jsp).
Transparency: The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant) have been explained.
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