by Moskowitz, Ari; Ross,
Catherine E.; Andersen, Lars W.; Grossestreuer, Anne V.; Berg, Katherine M.;
Donnino, Michael W.; for the American Heart Association’s Get With The
Guidelines – Resuscitation Investigators
Objectives:
Clinical providers have access to a number of pharmacologic agents during
in-hospital cardiac arrest. Few studies have explored medication administration
patterns during in-hospital cardiac arrest. Herein, we examine trends in use of
pharmacologic interventions during in-hospital cardiac arrest both over time
and with respect to the American Heart Association Advanced Cardiac Life
Support guideline updates.
Design:
Observational cohort study. Setting: Hospitals contributing data to the
American Heart Association Get With The Guidelines–Resuscitation database
between 2001 and 2016. Patients: Adult in-hospital cardiac arrest patients.
Interventions: The
percentage of patients receiving epinephrine, vasopressin, amiodarone,
lidocaine, atropine, bicarbonate, calcium, magnesium, and dextrose each year
were calculated in patients with shockable and nonshockable initial rhythms.
Hierarchical multivariable logistic regression was used to determine the annual
adjusted odds of medication administration. An interrupted time series analysis
was performed to assess change in atropine use after the 2010 American Heart
Association guideline update.
Measurements and Main Results: A total of 268,031 index in-hospital cardiac
arrests were included. As compared to 2001, the adjusted odds ratio of
receiving each medication in 2016 were epinephrine (adjusted odds ratio, 1.5;
95% CI, 1.3–1.8), vasopressin (adjusted odds ratio, 1.5; 95% CI, 1.1–2.1),
amiodarone (adjusted odds ratio, 3.4; 95% CI, 2.9–4.0), lidocaine (adjusted
odds ratio, 0.2; 95% CI, 0.2–0.2), atropine (adjusted odds ratio, 0.07; 95% CI,
0.06–0.08), bicarbonate (adjusted odds ratio, 2.0; 95% CI, 1.8–2.3), calcium
(adjusted odds ratio, 2.0; 95% CI, 1.7–2.3), magnesium (adjusted odds ratio,
2.2; 95% CI, 1.9–2.7; p < 0.0001), and dextrose (adjusted odds ratio, 2.8;
95% CI, 2.3–3.4). Following the 2010 American Heart Association guideline
update, there was a downward step change in the intercept and slope change in
atropine use (p < 0.0001). Conclusions: Prescribing patterns during
in-hospital cardiac arrest have changed significantly over time. Changes to
American Heart Association Advanced Cardiac Life Support guidelines have had a
rapid and substantial effect on the use of a number of commonly used in-hospital
cardiac arrest medications.
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