Abstract 247: Chest Tube Insertion, Needle Thoracostomy, And Pericardiocentesis During In-hospital Cardiac Arrest

Abstract

Introduction: Some causes of cardiac arrest, e.g. cardiac tamponade or tension pneumothorax, can only be reversed by an emergent invasive procedure; identification and treatment of these causes is critical during cardiopulmonary resuscitation. The use of emergent procedural interventions has not been comprehensively studied in the setting of in-hospital cardiac arrest (IHCA). Methods: Using the American Heart Association sponsored Get With The Guidelines ® -Resuscitation registry, we examined adult patients who received an invasive procedure (chest tube insertion (CTI), needle thoracostomy (NT), and/or pericardiocentesis (PC)) during IHCA between 2001 and 2020. Groups were compared using Fisher’s exact test for categorical variables and t-test or rank-sum for continuous variables. Outcomes were compared using multivariate hierarchical modeling accounting for clustering by hospital. Results: Of the 482,972 patients with IHCA, 11,304 (2.34%) had a procedure performed (1.24% CTI, 0.46% NT, 0.63% PC). PEA was a more likely initial rhythm in those who received a procedure compared to those who had no procedure (58.2% vs 47.8%, p<0.01), and VT or VF was less likely (8.8% vs 16.9%, p<0.01). Peri-arrest myocardial infarction was more likely in those who received PC compared to no procedure (21.7% vs 15.0%, p<0.01). Those who received CTI or NT were more likely to be on a ventilator than those with no procedure (67.9% vs 49.7%, p<0.01). The mean duration of resuscitation was longer for those with CTI, NT, and PC (29.0 min, 29.0 min, and 33.6 min) than for those who had no procedure (18.6 min, p<0.01). Patients who received CTI, NT, and PC had 7%, 20%, and 27% lower odds of ROSC respectively than patients who had no procedure (aOR 0.93, 95%CI 0.91 - 0.95, p<0.01; aOR 0.80, 95%CI 0.78 - 0.82, p<0.01; aOR 0.73, 95%CI 0.71 - 0.74, p<0.01), and 5%, 10%, and 12% lower odds of survival to discharge (aOR 0.95, 95%CI 0.94 - 0.96, p<0.01; aOR 0.90, 95%CI 0.89 - 0.92, p<0.01; aOR 0.88, 95%CI 0.87 - 0.89, p<0.01). Conclusions: We found important differences in patient characteristics and outcomes for those who received invasive procedures compared to those with no procedure. Those who received invasive procedures during IHCA had longer resuscitations but less ROSC and survival to discharge.