Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Boston, MA.
Crit Care Med. 2019 Feb;47(2):194-200. doi: 10.1097/CCM.0000000000003506.
Clinical providers have access to a number of pharmacologic agents during in-hospital cardiac arrest. Few studies have explored medication administration patterns during in-hospital cardiac arrest. Herein, we examine trends in use of pharmacologic interventions during in-hospital cardiac arrest both over time and with respect to the American Heart Association Advanced Cardiac Life Support guideline updates.
Observational cohort study.
Hospitals contributing data to the American Heart Association Get With The Guidelines-Resuscitation database between 2001 and 2016.
Adult in-hospital cardiac arrest patients.
The percentage of patients receiving epinephrine, vasopressin, amiodarone, lidocaine, atropine, bicarbonate, calcium, magnesium, and dextrose each year were calculated in patients with shockable and nonshockable initial rhythms. Hierarchical multivariable logistic regression was used to determine the annual adjusted odds of medication administration. An interrupted time series analysis was performed to assess change in atropine use after the 2010 American Heart Association guideline update.
A total of 268,031 index in-hospital cardiac arrests were included. As compared to 2001, the adjusted odds ratio of receiving each medication in 2016 were epinephrine (adjusted odds ratio, 1.5; 95% CI, 1.3-1.8), vasopressin (adjusted odds ratio, 1.5; 95% CI, 1.1-2.1), amiodarone (adjusted odds ratio, 3.4; 95% CI, 2.9-4.0), lidocaine (adjusted odds ratio, 0.2; 95% CI, 0.2-0.2), atropine (adjusted odds ratio, 0.07; 95% CI, 0.06-0.08), bicarbonate (adjusted odds ratio, 2.0; 95% CI, 1.8-2.3), calcium (adjusted odds ratio, 2.0; 95% CI, 1.7-2.3), magnesium (adjusted odds ratio, 2.2; 95% CI, 1.9-2.7; p < 0.0001), and dextrose (adjusted odds ratio, 2.8; 95% CI, 2.3-3.4). Following the 2010 American Heart Association guideline update, there was a downward step change in the intercept and slope change in atropine use (p < 0.0001).
Prescribing patterns during in-hospital cardiac arrest have changed significantly over time. Changes to American Heart Association Advanced Cardiac Life Support guidelines have had a rapid and substantial effect on the use of a number of commonly used in-hospital cardiac arrest medications.
在院内心脏骤停期间，临床医生可获得多种药物。很少有研究探讨院内心脏骤停期间药物管理模式。在此，我们研究了随着时间的推移以及随着美国心脏协会高级心脏生命支持指南更新，院内心脏骤停期间使用药物干预的趋势。
观察性队列研究。
2001 年至 2016 年期间向美国心脏协会 Get With The Guidelines-Resuscitation 数据库提供数据的医院。
院内心脏骤停的成年患者。
在有可电击和无电击初始节律的患者中，每年计算接受肾上腺素、血管加压素、胺碘酮、利多卡因、阿托品、碳酸氢盐、钙、镁和葡萄糖的患者比例。使用分层多变量逻辑回归确定药物使用的年度调整比值比。进行中断时间序列分析以评估 2010 年美国心脏协会指南更新后阿托品使用的变化。
共纳入 268031 例院内心脏骤停指数。与 2001 年相比，2016 年接受每种药物的调整比值比分别为肾上腺素（调整比值比，1.5；95%置信区间，1.3-1.8）、血管加压素（调整比值比，1.5；95%置信区间，1.1-2.1）、胺碘酮（调整比值比，3.4；95%置信区间，2.9-4.0）、利多卡因（调整比值比，0.2；95%置信区间，0.2-0.2）、阿托品（调整比值比，0.07；95%置信区间，0.06-0.08）、碳酸氢盐（调整比值比，2.0；95%置信区间，1.8-2.3）、钙（调整比值比，2.0；95%置信区间，1.7-2.3）、镁（调整比值比，2.2；95%置信区间，1.9-2.7；p<0.0001）和葡萄糖（调整比值比，2.8；95%置信区间，2.3-3.4）。美国心脏协会指南更新后，阿托品使用率的截距和斜率变化呈明显阶跃式下降（p<0.0001）。
随着时间的推移，院内心脏骤停期间的治疗模式发生了重大变化。美国心脏协会高级心脏生命支持指南的变化对许多常用的院内心脏骤停药物的使用产生了迅速而重大的影响。
