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Background Expert guidelines advocate defibrillation within 2 minutes after an in-hospital cardiac arrest caused by ventricular arrhythmia. However, empirical data on the prevalence of delayed defibrillation in the United States and its effect on survival are limited.
Methods We identified 6789 patients who had cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. Using multivariable logistic regression, we identified characteristics associated with delayed defibrillation. We then examined the association between delayed defibrillation (more than 2 minutes) and survival to discharge after adjusting for differences in patient and hospital characteristics.
Results The overall median time to defibrillation was 1 minute (interquartile range, <1 to 3 minutes); delayed defibrillation occurred in 2045 patients (30.1%). Characteristics associated with delayed defibrillation included black race, noncardiac admitting diagnosis, and occurrence of cardiac arrest at a hospital with fewer than 250 beds, in an unmonitored hospital unit, and during after-hours periods (5 p.m. to 8 a.m. or weekends). Delayed defibrillation was associated with a significantly lower probability of surviving to hospital discharge (22.2%, vs. 39.3% when defibrillation was not delayed; adjusted odds ratio, 0.48; 95% confidence interval, 0.42 to 0.54; P<0.001). In addition, a graded association was seen between increasing time to defibrillation and lower rates of survival to hospital discharge for each minute of delay (P for trend <0.001).
Conclusions Delayed defibrillation is common and is associated with lower rates of survival after in-hospital cardiac arrest.
Source Information
From Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.); the University of Michigan Division of Cardiovascular Medicine, Ann Arbor (P.S.C., B.K.N.); the Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, and the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital — all in New Haven, CT (H.M.K.); the University of Washington–Harborview Center for Prehospital Emergency Care, Seattle (G.N.); and the Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, MI (B.K.N.).
Address reprint requests to Dr. Chan at the Mid-America Heart Institute, 5th Fl., 4401 Wornall Rd., Kansas City, MO 64111, or at pchan{at}cc-pc.com.
Related Letters:
Time to Defibrillation after In-Hospital Cardiac Arrest
Chretien Y. R., Coylewright M., Chabbouh S., Ghiglione S., Mignon A., Ali B., Dudley S. C. Jr., Zafari A. M., Bassan M., Chan P. S., Nichol G., Nallamothu B. K., Saxon L. A.
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N Engl J Med 2008;
358:1631-1634, Apr 10, 2008.
Correspondence
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