Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Resuscitation. 2019 Apr;137:69-77. doi: 10.1016/j.resuscitation.2019.02.002. Epub 2019 Feb 13.
To determine whether the removal of atropine from the 2010 ACLS guidelines for non-shockable cardiac arrests was associated with a change in survival.
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.
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.
The removal of atropine from the 2010 guidelines was not associated with a significant change in survival.
确定 2010 年 ACLS 指南中取消心脏停搏时非颤动心外按压患者应用阿托品是否与存活率变化相关。
我们使用 Get With The Guidelines-Resuscitation 注册研究,纳入了 2006 至 2015 年期间索引性院内心脏骤停的成年患者。主要转归为出院时存活。次要转归包括自主循环恢复和良好的功能结局。我们采用中断时间序列分析比较了指南发布前后(前指南期和后指南期)的存活率。采用差异中的差异方法,比较了非颤动和颤动队列的中断时间序列结果,以说明与阿托品无关的指南变化。
我们纳入了 20499 例非颤动性和 3968 例颤动性心脏骤停。前指南期和后指南期患者特征相似。前指南期非颤动性心脏骤停中 8653 例(87%)和颤动性心脏骤停中 680 例(35%)应用了阿托品,后指南期非颤动性心脏骤停中 3643 例(35%)和颤动性心脏骤停中 320 例(16%)应用了阿托品。与颤动性心脏骤停相比,非颤动性心脏骤停从前指南期到后指南期的存活率变化时间没有显著差异(风险差异:每年 2.0%[95%CI:-0.8,4.8],p=0.17)。指南发布后即刻存活率变化在两个队列之间也没有差异(风险差异:3.5%[95%CI:-2.6,9.7],p=0.26)。次要结局和多次敏感性分析结果相似。
2010 年指南中取消阿托品的使用与存活率的显著变化无关。