Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest

RESUSCITATION

卷:155

Article

Hessulf, Fredrik^1,2  Herlitz, Johan^2,3,4  Rawshani, Araz²  Aune, Solveig⁵  Israelsson, Johan^6,7,8  Sodersved-kallestedt, Marie-Louise⁹  Nordberg, Per¹⁰  Lundgren, Peter^1,2,11  Engdahl, Johan^2,12 

[1] Halland Hosp, Dept Anaesthesiol & Intens Care Med, SE-30185 Halmstad, Sweden

[2] Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden

[3] PreHospen Ctr Prehosp Res, SE-50190 Boras, Sweden

[4] Univ Bores, Acad Caring Sci Welf & Work Life, SE-50190 Boras, Sweden

[5] Provider Governance & Coordinat, Unit EMS Coordinat, Vastra Gotaland, Region Vastra G, Sweden

[6] Kalmar Cty Hosp, Dept Internal Med, Div Cardiol, Kalmar, Sweden

[7] Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden

[8] Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden

[9] Uppsala Univ, Ctr Clin Res, Vasteras, Sweden

[10] Soder Sjukhuset, Karolinska Inst, Inst Clin Res & Educ, Stockholm, Sweden

[11] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden

[12] Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Div Cardiovasc Med, Stockholm, Sweden

关键词: In-hospital cardiac arrest;    Cardiopulmonary resuscitation;    Chain of survival;    Guidelines;   

DOI  :  10.1016/j.resuscitation.2020.07.009

来源: Elsevier

【 摘 要 】

Background: Most resuscitation guidelines have recommendations regarding maximum delay times from collapse to calling for the rescue team and initiation of treatment following cardiac arrest. The aim of the study was to investigate the association between adherence to guidelines for cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest (IHCA) and survival with a focus on delay to treatment. Methods: We used the Swedish Registry for CPR to study 3212 patients with a shockable rhythm and 9113 patients with non-shockable rhythm from January 1, 2008 to December 31, 2017. Adult patients older than or equal to 18 years with a witnessed IHCA where resuscitation was initiated were included. We assessed trends in adherence to guidelines and their associations with 30-day survival and neurological function. Adherence to guidelines was defined as follows: time from collapse to calling for the rescue team and CPR within 1 min for non-shockable rhythms. For shockable rhythms, adherence was defined as the time from collapse to calling for the rescue team and CPR within 1 min and defibrillation within 3 min. Results: In patients with a shockable rhythm, the 30-day survival for those treated according to guidelines was 66.1%, as compared to 46.5% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.84 (95% CI 1.52-2.22). Among patients with a non-shockable rhythm the 30-day survival for those treated according to guidelines was 22.8%, as compared to 16.0% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.43 (95% CI 1.24-1.65). Neurological function (cerebral performance category 1-2) among survivors was better among patients treated in accordance with guidelines for both shockable (95.7% vs 91.1%, <0.001) and non-shockable rhythms (91.0% vs 85.5%, p < 0.008). Adherence to the Swedish guidelines for CPR increased slightly 2008-2017. Conclusions: Adherence to guidelines was associated with increased probability of survival and improved neurological function in patients with a shockable and non-shockable rhythm, respectively. Increased adherence to guidelines could increase cardiac arrest survival.

【 授权许可】

Free