Patients with Delayed In-Hospital Defibrillation Have Lower Survival
January 3, 2008 - A study reported in the Jan. 3 New England Journal of Medicine found that one third of patients who had in-hospital cardiac arrest received delayed defibrillation, which is associated with lower rates of survival.
The study “Delayed Time to Defibrillation and Survival After In-Hospital Cardiac Arrest” evaluated data from 369 hospitals with 6,789 patients who suffered cardiac arrests with the first identifiable rhythm being ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) between Jan. 1, 2000 and July 31, 2005. The study used data from the American Heart Association’s National Registry of CPR (NRCPR), a database of in-hospital resuscitation events, treatments and outcomes.
Researchers reported that 34.1 percent of patients survived to hospital discharge. Nearly one-third of patients (30.1 percent) received delayed defibrillation, defined as time to defibrillation of greater than 2 minutes, after the arrest began.
Delayed defibrillation was associated with a significantly lower probability of survival to hospital discharge (22.2 percent vs. 39.3 percent when defibrillation was not delayed). Every minute of delay until defibrillation was associated with lower rates of survival to hospital discharge. In addition, patients who survived to hospital discharge but experienced delayed defibrillation were less likely to have no major neurological disability.
The study noted certain hospital-level factors were associated with delayed defibrillation. These included cardiac arrests in small hospitals (less than 250 beds), in unmonitored hospital units, and after hours (weeknights and weekends). This suggests that improving times to defibrillation for cardiac arrests may require well-planned interventions in hospital processes to ensure that life-saving defibrillation is administered as promptly as possible for all patients. However, the authors said future study was necessary to identify effective strategies for reducing times to defibrillation.
The American Heart Association’s 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care note that early CPR and defibrillation are critical to survival from sudden cardiac arrest.
In hospitals where defibrillation is performed infrequently or where staff is not trained to use a manual defibrillator, the American Heart Association recommends using an automated external defibrillator (AED) to help deliver early defibrillation and recommends that hospitals develop a comprehensive program for AED use that includes identifying and training likely responders and performing device maintenance.
The NRCPR provides an evidence-based, quality improvement program that allows hospitals to improve patient care and outcomes. The NRCPR database also provides researchers data to study how to improve future resuscitation treatments. The American Heart Association provides oversight for the database.
For more information: www.nrcpr.org, www.americanheart.org