Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest

Abstract

Background: Most resuscitation guidelines have recommendations regarding maximum delay times from collapse to calling for the rescue team and initiation of treatment following cardiac arrest. The aim of the study was to investigate the association between adherence to guidelines for cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest (IHCA) and survival with a focus on delay to treatment.Methods: We used the Swedish Registry for CPR to study 3212 patients with a shockable rhythm and 9113 patients with non-shockable rhythm from January 1, 2008 to December 31, 2017. Adult patients older than or equal to 18 years with a witnessed IHCA where resuscitation was initiated were included. We assessed trends in adherence to guidelines and their associations with 30-day survival and neurological function. Adherence to guidelines was defined as follows: time from collapse to calling for the rescue team and CPR within 1 min for non-shockable rhythms. For shockable rhythms, adherence was defined as the time from collapse to calling for the rescue team and CPR within 1 min and defibrillation within 3 min.Results: In patients with a shockable rhythm, the 30-day survival for those treated according to guidelines was 66.1%, as compared to 46.5% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.84 (95% CI 1.52À2.22). Among patients with a nonshockable rhythm the 30-day survival for those treated according to guidelines was 22.8%, as compared to 16.0% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.43 (95% CI 1.24À1.65). Neurological function (cerebral performance category 1À2) among survivors was better among patients treated in accordance with guidelines for both shockable (95.7% vs 91.1%, <0.001) and non-shockable rhythms (91.0% vs 85.5%, p < 0.008). Adherence to the Swedish guidelines for CPR increased slightly 2008À2017.

Cohort study of the characteristics and outcomes in patients with COVID-19 and in-hospital cardiac arrest

“…The registry has previously been described in detail. 9 Vital status was obtained from the Swedish Population Registry and the last day of follow-up was 31 December 2020.…”

“…The data is collected by trained nurses who report patient data using a web-based protocol. The registry has previously been described in detail 9. Vital status was obtained from the Swedish Population Registry and the last day of follow-up was 31 December 2020.…”

Comparison of two strategies for managing in-hospital cardiac arrest

“…In both groups, adherence to guidelines was high, and the rapid initiation of CPR and early defibrillation after the recognition of IHCA were ensured. Our findings emphasise that, regardless of where the cardiac arrest occurs, early CPR initiation and early defibrillation of a shockable rhythm is more crucial for patient prognosis than ACLS measures since every minute of a delay increases the risk of patient mortality 5 , 19 , 20 .…”

“…Mortality after IHCA is high, and the neurological outcome after the return of spontaneous circulation (ROSC) remains dismal 2 , 3 . Approximately every fourth IHCA patient survives to discharge 4 , 5 . Strategies to manage out-of-hospital cardiac arrest (OHCA) have been widely researched 6 , 7 , but little is known about the best management of IHCA to improve outcomes.…”

Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response

“…During pediatric in-hospital cardiac arrest resuscitation, deviating from hospital protocols, particularly care involving medications, CPR, defibrillation, and vascular access, is associated with decreased survival ( 10 ). Adherence to protocols during in-hospital cardiac arrest in adults has been shown to increase 30-day survival and lead to more favorable neurological outcomes ( 25 ). Though our study was underpowered to show an association between deviations and survival, deviations from protocols are known to influence survival and should be considered as modifiable risk factors to improve survival.…”