Acute cardiac care & resuscitation
Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest
Authors' conclusion
Prompt defibrillation for IHCA caused by ventricular tachycardia or ventricular fibrillation was associated with higher rates of long-term survival throughout 5 years of follow-up, whereas prompt epinephrine treatment for asystole/pulseless electric activity was associated with greater survival at 1 year but not at 3 or 5 years.
Study context
- Population
- Patients ≥65 years with in-hospital cardiac arrest at 517 US hospitals, 2000–2011
- Participants
- 36,961 patients · 517 hospitals
- Exposure
- Prompt vs delayed defibrillation and prompt vs delayed epinephrine
- Prompt defibrillationn = 5,714
- Delayed defibrillationn = 2,405reference
- Prompt epinephrinen = 24,885
- Delayed epinephrinen = 3,957reference
- Outcome
- Long-term survival
- Follow-up
- 1, 3 and 5 years
Methodological detailsregistry linked with Medicare, multicentre
- Registry linked with Medicare
- Multicentre
Main finding
As reported in the abstract
1-year survival · 1 year
Adjusted RR for 1-year survival (95% CI)P value
Prompt defibrillation vs Delayed defibrillationVT/VF, n = 8119
1.49(1.32–1.69)
P < 0.0001Prompt epinephrine vs Delayed epinephrineasystole/PEA, n = 28 842
1.20(1.02–1.41)
P = 0.02Observational data: associations, not effects.
Further findings
| Outcome | Prompt defibrillation | Delayed defibrillation | Prompt epinephrine | Delayed epinephrine | Estimate | P value | |
|---|---|---|---|---|---|---|---|
| 3-year survival · 3 yearsPrompt defibrillation vs Delayed defibrillation | 19.1% | 11.0% | 3.5% | 2.9% | adjusted RR for 3-year survival 1.45 (95% CI 1.23–1.69) | P < 0.0001 | |
| 3-year survival · 3 yearsPrompt epinephrine vs Delayed epinephrine | adjusted RR for 3-year survival 1.17 (95% CI 0.95–1.45) | P = 0.15 | |||||
| 5-year survival · 5 yearsPrompt defibrillation vs Delayed defibrillation | 14.7% | 7.9% | 2.3% | 1.9% | adjusted RR for 5-year survival 1.50 (95% CI 1.22–1.83) | P < 0.0001 | |
| 5-year survival · 5 yearsPrompt epinephrine vs Delayed epinephrine | adjusted RR for 5-year survival 1.18 (95% CI 0.88–1.58) | P = 0.27 | |||||
| 0.512Ratio (log scale) |
Original publication
Association Between Prompt Defibrillation and Epinephrine Treatment With Long-Term Survival After In-Hospital Cardiac Arrest. Circulation. Published 26 December 2017. doi:10.
Summarised from the published abstract; every number is checked against it