Abstract 239: Frequency of Advanced Cardiac Life Support Medication Use and Association With Survival During In-Hospital Cardiac Arrest

Abstract

Introduction: Resuscitation medication shortages are widespread across the US. We sought to determine the frequency and quantity of meds used during IHCA. Methods: Retrospective, single center, chart review at a large, urban teaching hospital. Adults over 18 who suffered IHCA between Jan 2017 and Mar 2018 were identified. Trained and supervised research assistants used a standardized data tool to extract data from the EMR. Primary outcome was the frequency and quantity of ACLS meds used during IHCA. Secondary outcomes included evaluating the association of med administration with ROSC and survival as well as the use of sodium bicarb with survival in patients with pre-existing end stage renal disease. Results: Criteria were met for 181 IHCA events. Demographics: 71% (128 of 181) black; mean age 65; and 46% (83 of 181) women. Epi was given in 86.7% (157 of 181) cases, with average cumulative dose of 4.2 mg, sodium bicarb given in 63.5% (115 of 181), average dose of 1.9 amps, calcium chloride given in 39.2% (71 of 181), average dose of 1.9 amps, amiodarone was given in 30.9% (56 of 181), average dose of 311.8 mg, and atropine was given in 13.8% (25 of 181), average dose of 1.3 amps. Administration of sodium bicarb was associated with lower rates of ROSC (OR 0.31, 95% CI 0.18 to 0.83) and lower survival (OR 0.31, 95% CI 0.13 to 0.73). Administration of mag sulfate was associated with lower rates of ROSC (OR 0.33, 95% CI 0.13 to 0.83), but no difference in survival (OR 0.34, 95% CI 0.10 to 1.14). Administration of epi, amiodarone, calcium, dextrose, or atropine was not associated with a change in rates of ROSC or survival. In patients with pre-existing ESRD (45 of 181), 73.3% (33 of 45) received sodium bicarb, with 51.5% (17 of 33) achieving ROSC, and 12.1% (4 of 33) surviving to discharge. In patients without ESRD (136 of 181), 60.3% (82 of 136) received sodium bicarb, with 65.9% (54/82) achieving ROSC, and 22.0% (18 of 82) surviving to discharge. (12.1% vs 22.0% p = 0.224). Conclusions: Substantial amounts of drugs with known recent shortage are used in IHCA with no significant increase in ROSC or survival to discharge. Administration of sodium bicarb during IHCA is associated with lower rates of ROSC and survival. These results may be due to confounders such as code duration.