Guideline removal of atropine and survival after adult in-hospital cardiac arrest with a non-shockable rhythm.

Abstract

AIM:

To determine whether the removal of atropine from the 2010 ACLS guidelines for non-shockable cardiac arrests was associated with a change in survival.

METHODS:

Using the Get With The Guidelines®-Resuscitation registry, we included adults with an index in-hospital cardiac arrest between 2006 and 2015. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable functional outcome. An interrupted time-series analysis was used to compare survival before (pre-guidelines) and after (post-guidelines) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine.

RESULTS:

We included 20,499 non-shockable and 3968 shockable cardiac arrests. Patient characteristics were similar between the pre-guidelines and post-guidelines period. Atropine was used for 8653 (87%) non-shockable and 680 (35%) shockable cardiac arrests in the pre-guidelines period and 3643 (35%) non-shockable and 320 (16%) shockable cardiac arrests in the post-guidelines period. The change over time in survival from the pre-guidelines to the post-guidelines period was not significantly different for the non-shockable compared to the shockable cohort (risk difference: 2.0% [95%CI: -0.8, 4.8] per year, p = 0.17). The immediate change in survival after introducing the guidelines was also not different between the cohorts (risk difference: 3.5% [95%CI: -2.6, 9.7], p = 0.26). Results were similar for the secondary outcomes and in multiple sensitivity analyses.

CONCLUSIONS:

The removal of atropine from the 2010 guidelines was not associated with a significant change in survival.

• Authors: Mathias J Holmberg, Ari Moskowitz, Sebastian Wiberg, Anne V Grossestreuer, Tuyen Yankama, Lise Witten, Sarah M Perman, Michael W Donnino, Lars W Andersen, American Heart Association’s Get With The Guidelines®-Resuscitation Investigators
• Journal: Resuscitation (Resuscitation) Vol. 137 Pg. 69-77 (04 2019) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 30771452 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Chemical References

• Anti-Arrhythmia Agents
• Atropine

Topics

• Aged
• Anti-Arrhythmia Agents (administration & dosage)
• Atropine (administration & dosage)
• Electric Countershock
• Female
• Heart Arrest (drug therapy, mortality)
• Humans
• Interrupted Time Series Analysis
• Male
• Middle Aged
• Practice Guidelines as Topic
• Propensity Score
• Prospective Studies
• Registries
• Survival Rate
• United States