Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest
Authors' conclusion
Delays in epinephrine administration following in-hospital cardiac arrest are common and variy across hospitals. Hospitals with high rates of delayed epinephrine administration had lower rates of overall survival for in-hospital cardiac arrest attributable to nonshockable rhythm.
Study context
- Population
- Adults (≥18 years) with in-hospital cardiac arrest from a nonshockable rhythm who received ≥1 dose of epinephrine, 2000–2014
- Participants
- 103,932 adults · 548 hospitals
- Exposure
- Hospitals by rate of delayed epinephrine
- Outcome
- Hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge and survival with functional recovery
Methodological detailsregistry (Get With The Guidelines-Resuscitation), 2-level hierarchical regression models, 548 hospitals
- Registry (Get With The Guidelines-Resuscitation)
- 2-level hierarchical regression models
- 548 hospitals
Main finding
As reported in the abstract
Delayed epinephrine (>5 minutes) and hospital variation
- Patients with delays to epinephrine
- 13 213 (12.7%)
- Hospital rate of delay, range
- 0%-53.8%
- Median OR for delay (1 random hospital vs another), 95% CI 1.51-1.64
- 1.58
- Correlation of hospital delay rate with risk-standardized survival to discharge (P<0.0001)
- ρ=−0.22
- Correlation of hospital delay rate with risk-standardized survival with functional recovery (P=0.001)
- ρ=−0.14
Observational data: associations, not effects.
Further findings
| Outcome | Lowest quartile of epinephrine delay | Highest quartile of epinephrine delay |
|---|---|---|
| Risk-standardized survival to discharge, by hospital quartile of epinephrine delay | median 12.9% (IQR 11.1%–15.4%) | 10.8% (IQR 9.7%–12.7%) |
- Risk-standardized survival to discharge, by hospital quartile of epinephrine delay — Risk-standardized survival lower at highest-delay quartile hospitals
- 16%
Hospital risk-standardized outcomes (all hospitals)
- Median risk-standardized survival rate (range 5.4%-31.9%)
- 12.0%
- Risk-standardized survival with functional recovery (range 0.9%-30.8%)
- 7.4%
Original publication
Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest. Circulation. Published 1 December 2016. doi:10.
Summarised from the published abstract; every number is checked against it