Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest.
Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest.
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DOI：
10.1161/circulationaha.116.025459
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发表时间：
2016-12-20
期刊：
影响因子：
37.8
通讯作者：
American Heart Association’s Get With The Guidelines-Resuscitation Investigators
中科院分区：
文献类型：
--
作者：
Khera R;Chan PS;Donnino M;Girotra S;American Heart Association’s Get With The Guidelines-Resuscitation Investigators
对于因非电击节律导致院内心脏骤停的患者，肾上腺素给药延迟超过5分钟与生存较差相关。然而，延迟肾上腺素给药的医院变异程度及其对医院水平结果的影响尚不清楚。在GET WITH指南-复苏范围内，我们在548家医院确定了103,932名成年患者(≥18岁)，他们在2000年至2014年期间接受了至少1剂肾上腺素治疗，由于不可电击的节律而发生了院内心脏骤停。我们构建了两级分级回归模型来量化医院肾上腺素延迟给药率(>；5分钟)的变化及其与医院存活率、出院存活率和功能恢复存活率的关系。总体而言，13,213名患者(12.7%)肾上腺素治疗延迟，这一比例在不同医院之间存在显著差异(范围：0%至53.8%)。与另一家随机选择的医院的类似患者相比，在一家随机选择的医院，肾上腺素延迟给药的几率高58%(中位优势比[OR]1.58；95%C.I.1.51-1.64)。中位风险标化生存率为12.0%(5.4%~31.9%)，功能恢复风险标化生存率为7.4%(0.9%~30.8%)。医院延迟给予肾上腺素的比率与其风险标准化存活率(ρ=−0.22，P<；0.0001)和功能恢复的存活率(ρ=−0.14，P=0.001)呈负相关。与肾上腺素延迟率最低四分之一的医院的中位存活率12.9%(四分位数范围11.1%至15.4%)相比，肾上腺素延迟率最高的四分位数医院的风险标准化生存率低16%(10.8%，四分位数范围：9.7%至12.7%)。院内心脏骤停后肾上腺素给药延迟是常见的，不同医院的情况有所不同。肾上腺素延迟给药比率高的医院由于非电击节律，院内心脏骤停的总体存活率较低。需要进一步的研究来确定改善肾上腺素治疗的医院绩效是否会带来改善的结果，特别是在这一指标表现不佳的医院。
For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (≥18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify 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. Overall, 13,213 (12.7%) patients had delays to epinephrine, and this rate varied markedly across hospitals (range: 0% to 53.8%). The odds of delay in epinephrine administration were 58% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.58; 95% C.I. 1.51 – 1.64). Median risk-standardized survival rate was 12.0% (range: 5.4% to 31.9%) and risk-standardized survival with functional recovery was 7.4% (range: 0.9% to 30.8%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge (ρ= −0.22, P<0.0001) and survival with functional recovery (ρ= −0.14, P=0.001). Compared to a median survival rate of 12.9% (interquartile range 11.1% to 15.4%) at hospitals in the lowest quartile of epinephrine delay, risk-standardized survival was 16% lower at hospitals in the quartile with the highest rate of epinephrine delays (10.8%, interquartile range: 9.7% to 12.7%). Delays in epinephrine administration following in-hospital cardiac arrest are common and varies across hospitals. Hospitals with high rates of delayed epinephrine administration had lower rates of overall survival for in-hospital cardiac arrest due to non-shockable rhythm. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improved outcomes.