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Effects of Delayed Defibrillation After In-Hospital Cardiac Arrest

Registry data suggest that one third of the patients who would benefit most are not receiving timely defibrillation.

In the U.S., in-hospital cardiac arrest occurs about twice as often as out-of-hospital cardiac arrest and is associated with poor survival rates. Current recommendations for cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) call for defibrillation within 2 minutes. To explore how often such timely therapy actually occurs and the possible negative effects of delayed defibrillation on clinical outcomes, investigators studied data on hospitalized adult patients with cardiac arrest due to VF or pulseless VT from the American Heart Association National Registry of CardioPulmonary Resuscitation.

Of 6789 patients in 369 U.S. hospitals included in the analysis, 34.1% survived to hospital discharge. Although the median time to defibrillation was 1 minute, 30.1% of patients received defibrillation after the recommended 2 minutes. Independent correlates of delayed defibrillation included black race, cardiac arrest after hours (between 5 PM and 8 AM), cardiac arrest occurring in an unmonitored bed, hospital size of <250 beds, and a noncardiac admission diagnosis. Defibrillation after more than 2 minutes was associated with a significantly reduced probability of survival (22.5% vs. 39.3%; adjusted odds ratio, 0.48), and there was a graded association between increasing time to defibrillation and higher mortality.

Comment: This study validates current recommendations for prompt defibrillation for patients with in-hospital tachyarrhythmic cardiac arrest. Even in hospitals voluntarily participating in a national registry — which presumably implies a commitment to quality — prompt defibrillation is not provided to almost one third of such patients. To reduce time to defibrillation, the author of an accompanying editorial suggests improvements in detection (with automated algorithms in telemetry units) and in access to treatment (with wider in-hospital availability of automated external defibrillators). The diffusion of such technology may reduce disparities in treatment and improve outcomes in patients with in-hospital cardiac arrest.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology January 2, 2008

Citation(s):

Chan PS et al. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008 Jan 3; 358:9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Saxon LA. Survival after tachyarrhythmic arrest — What are we waiting for? N Engl J Med 2008 Jan 3; 358:77.

• Original article (Subscription may be required)
• Medline abstract (Free)