Resuscitation 85 (2014) 350–358
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Clinical paper
Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: A retrospective review of prospectively collected data夽 Sam A. Warren a,b,c,∗ , Ella Huszti a,b , Steven M. Bradley b,f , Paul S. Chan d,e , Chris L. Bryson b,f , Annette L. Fitzpatrick c,g,h , Graham Nichol a,b,i , for the American Heart Association’s Get With the Guidelines-Resuscitation (National Registry of CPR) Investigators1 a
University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States Department of Medicine, Seattle, WA, United States c Department of Epidemiology, Seattle, WA, United States d Saint Luke’s Mid-America Heart and Vascular Institute, Kansas City, MO, United States e University of Missouri-Kansas City, Kansas City, MO, United States f Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States g University of Washington, Collaborative Health Studies Coordinating Center, United States h University of Washington, Department of Global Health, Seattle, WA, United States i Clinical Trial Center, Department of Biostatistics, Seattle, WA, United States b
a r t i c l e
i n f o
Article history: Received 22 July 2013 Received in revised form 21 September 2013 Accepted 2 October 2013 Keywords: Arrhythmia Cardiopulmonary resuscitation Heart arrest Pharmacology
a b s t r a c t Background and aim: Expert guidelines for treatment of cardiac arrest recommend administration of adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of epinephrine remain unclear. We sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA). Methods: We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Epinephrine average dosing period was defined as the time between the first epinephrine dose and the resuscitation endpoint, divided by the total number of epinephrine doses received subsequent to the first epinephrine dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. Results: Compared to a referent epinephrine average dosing period of 4 to
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Clinical paper
Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: A retrospective review of prospectively collected data夽 Sam A. Warren a,b,c,∗ , Ella Huszti a,b , Steven M. Bradley b,f , Paul S. Chan d,e , Chris L. Bryson b,f , Annette L. Fitzpatrick c,g,h , Graham Nichol a,b,i , for the American Heart Association’s Get With the Guidelines-Resuscitation (National Registry of CPR) Investigators1 a
University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, United States Department of Medicine, Seattle, WA, United States c Department of Epidemiology, Seattle, WA, United States d Saint Luke’s Mid-America Heart and Vascular Institute, Kansas City, MO, United States e University of Missouri-Kansas City, Kansas City, MO, United States f Health Services Research and Development Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States g University of Washington, Collaborative Health Studies Coordinating Center, United States h University of Washington, Department of Global Health, Seattle, WA, United States i Clinical Trial Center, Department of Biostatistics, Seattle, WA, United States b
a r t i c l e
i n f o
Article history: Received 22 July 2013 Received in revised form 21 September 2013 Accepted 2 October 2013 Keywords: Arrhythmia Cardiopulmonary resuscitation Heart arrest Pharmacology
a b s t r a c t Background and aim: Expert guidelines for treatment of cardiac arrest recommend administration of adrenaline (epinephrine) every three to five minutes. However, the effects of different dosing periods of epinephrine remain unclear. We sought to evaluate the association between epinephrine average dosing period and survival to hospital discharge in adults with an in-hospital cardiac arrest (IHCA). Methods: We performed a retrospective review of prospectively collected data on 20,909 IHCA events from 505 hospitals participating in the Get With The Guidelines-Resuscitation (GWTG-R) quality improvement registry. Epinephrine average dosing period was defined as the time between the first epinephrine dose and the resuscitation endpoint, divided by the total number of epinephrine doses received subsequent to the first epinephrine dose. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. Results: Compared to a referent epinephrine average dosing period of 4 to
