Resuscitation Registry Research Articles

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.

OUTCOMES OF CARDIAC ARREST BETWEEN REALITY AND TELEVISION MEDICAL DRAMAS: RESULTS OF THE TVMD2 STUDY

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Outcomes of cardiopulmonary resuscitation (CPR) include: death, return of spontaneous circulation (ROSC), sustained ROSC, and discharge from hospital, among others. We aimed to assess if television medical dramas (TVMDs) depictions of CPR outcomes are representative of reality. METHODS: An instrument was created to address quality of CPR in TVMD. It was applied by advanced cardiac life support (ACLS) certified-health care providers, to assess and review CPR scenarios performance and outcomes from 32 different TVMDs from 2010 to 2018. Data was evaluated to explore CPR outcomes. RESULTS: A total of 836 episodes of TVMDs were reviewed with a total of 212 on-screen CPR attempts; of which, 202 revealed the outcome. CPR success rate was 61.9% (n=125). In 189 CPR scenes, patient’s condition was followed during the hospitalization, and 54% (n=102) survived to hospital discharge. Of the survivors, we were able to assess the cerebral performance category (CPC) score in 88 patients. 96.5% (n=85) had favorable neurological outcome (CPC 1,2) and only 3.5% (n=3) had unfavorable neurological outcome (CPC 3,4 and5). Moreover, we assessed if determination of ROSC in TVMDs complied with the Utstein Resuscitation Registry Templates (by spontaneously restoring a palpable pulse or a measurable blood pressure). We found that from 160 episodes, in which we could assess how ROSC was determined, only 30% (n=48) depended on the pulse; while 56.3% (n=90) used the monitor. Other methods to identify ROSC were echocardiography in 3.75% (n=6), waking up in 9.38% (n=15), breathing in 4.38% (n=7), and coughing in 2.5% (n=4) of the patients. CONCLUSIONS: The success rate of CPR and neurological outcomes for survivors in TVMDs are better than outcomes among real patients. ROSC identification also varied from common clinical practice. TVMDs portrayal of CPR outcomes significantly misrepresents outcomes in reality. CLINICAL IMPLICATIONS: TVMDs are a major source of medical education among lay people. Inadequate representation of CPR outcomes may give families false hope. DISCLOSURES: No relevant relationships by Abbas Alshami, source=Web Response Advisory Committee Member relationship with Zoll Please note: $5001 - $20000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Travel<br Advisory Committee Member relationship with Medtronic Please note: $20001 - $100000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Intellectual property rights Advisory Committee Member relationship with Diasorin Please note: $1001 - $5000 Added 03/14/2019 by Sharon Einav, source=Web Response, value=Grant/Research Support No relevant relationships by Luz Ramirez, source=Web Response No relevant relationships by Joseph Varon, source=Web Response No relevant relationships by Daryelle Varon, source=Web Response

P6385Association of prehospital acetylsalicylic acid and heparin administration with favourable neurological outcome after out-of-hospital cardiac arrest: a matched-pair analysis

Abstract Background/Introduction To date, no prehospital administered drug has shown to influence favourable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA). Early administration of antiplatelet and anticoagulant medication might affect organ microcirculation and therefore favourable neurological outcome in the setting of OHCA. Purpose To evaluate the effect of prehospital acetylsalicylic acid and heparin (AH) administration on favourable neurological outcome and overall survival after OHCA in a large multicentre registry. Methods We examined patients with cardiac causes of OHCA that were prospectively included in the German Resuscitation Registry. Patients that were administered AH in the prehospital setting were matched in a 1:4 ratio with patients that were not administered AH. Pairs were matched for age &gt;80 years, public place of collapse, initial ECG rhythm, witnessed by lay people and by emergency medical services (EMS), bystander CPR, usage of vasopressors, ECG signs of ACS or diagnosed ACS, coronary angiography conducted and hypothermia conducted. Analyses in the patients were stratified by treatment arm. Data was collected from 2011 to 2017 and analysed from January 2019 to March 2019. The primary endpoint was favourable neurological outcome at hospital discharge defined as cerebral performance category (CPC) 1 or 2. Secondary endpoints were return of spontaneous circulation (ROSC) as well as survival to hospital discharge. Logistic regression analysis and chi square analysis were used to evaluate the primary and secondary endpoints, respectively. Results Within the German Resuscitation Registry, 17,139 patients included between 2011 and 2017 had a presumably cardiac cause of OHCA with completed follow-up data. 205 patients were administered AH in the prehospital setting, whereas 16,934 were not. After matching in a 1:4 ratio, 174 patients in the AH group and 696 in the noAH group were suitable for analysis of the primary and the secondary endpoints. Prehospital AH administration was associated with favourable neurological outcome (OR for CPC 1 or 2 at hospital discharge 1.489 [1.026–2.162], p=0.036). Patients with AH were more likely to have ROSC (73.6% vs. 65.7% in the noAH group, p=0.047). Survival to hospital discharge was not statistically different between groups (32.8% vs. 28.5% in the noAH group). Consort flow-diagram Conclusion(s) In this matched-pair analysis, prehospital administration of AH was associated with an enhanced ROSC rate and with favorable neurological outcome. Randomized controlled trials are needed to confirm these results.

4250Sports-related sudden cardiac arrest in Germany

Abstract Background Knowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Purpose We established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany. Methods The registration of SrSCA based upon 4 pillars: a) a web-based platform to record SrSCA cases in competitive and recreational athletes, b) media-monitoring and c) a cooperation with the German Resuscitation Registry as well as d) 15 institutes of forensic medicine. Results After an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0±12.7 years) of which 109 subjects survived. Most of the cases occurred during non-elite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%), however rhythm analysis and defibrillation (if indicated) was mainly performed by medical service. In subjects ≤35 years, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥35 years, CAD predominated. Conclusion The prevalence of cardiac pathologies in young athletes seems to vary across different countries. CAD represents the most common cause of SrSCA in the general population of Germany, highlighting the need for a targeted cardiovascular risk evaluation including young athletes. Public education on basic life support including the appropriate use of an automated external defibrillator (AED) may further decrease the burden of sudden cardiac death. Acknowledgement/Funding Funding from the German Heart Foundation

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research.

Establishing the crimean out-of-hospital cardiac arrest and resuscitation registry (COHCARR): a baseline epidemiological analysis

Purpose of the study: To evaluate epidemiology of out-of-hospital cardiac arrest (OHCA) and performance of emergency medical services (EMS) in the Crimea.

Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States

Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized adult and pediatric patients across the United States. The aim of this study was to estimate the contemporary annual incidence of in-hospital cardiac arrest in adults and children across the United States and to describe trends in incidence between 2008 and 2017. Using the Get With The Guidelines– Resuscitation registry, we developed a negative binomial regression model to estimate the incidence of index pulseless in-hospital cardiac arrest based on hospital-level characteristics. The model was used to predict the number of in-hospital cardiac arrests in all US hospitals, using data from the American Hospital Association Annual Survey. We performed separate analyses for adult (≥18 years) and pediatric (<18 years) cardiac arrests. Additional analyses were performed for recurrent cardiac arrests and pediatric patients requiring cardiopulmonary resuscitation for poor perfusion (nonpulseless events). The average annual incidence of in-hospital cardiac arrest in the United States was estimated at 292 000 (95% prediction interval, 217 600–503 500) adult and 15 200 pediatric cases, of which 7100 (95% prediction interval, 4400–9900) cases were pulseless cardiac arrests and 8100 (95% prediction interval, 4700–11 500) cases were nonpulseless events. The rate of adult cardiac arrests increased over time, while pediatric events remained more stable. When including both index and recurrent inhospital cardiac arrests, the average annual incidence was estimated at 357 900 (95% prediction interval, 247 100–598 400) adult and 19 900 pediatric cases, of which 8300 (95% prediction interval, 4900–11 200) cases were pulseless cardiac arrests and 11 600 (95% prediction interval, 6400–16 700) cases were nonpulseless events. There are ≈292 000 adult in-hospital cardiac arrests and 15 200 pediatric in-hospital events in the United States each year. This study provides contemporary estimates of the public health burden of cardiac arrest among hospitalized patients.

One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest

ObjectivesFew studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression,...

Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest

ObjectiveTo describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA). DesignRetrospective observational study. SettingAnalysis of data extracted from a national cardiac arrest registry. Study populationPatients >18 years old with IHCA from January 2015 up to June 2017. Outcome measuresPrimary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1–2. ResultsOf 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline. ConclusionsIn our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.

Prospective validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for in-hospital cardiac arrest prognosis

AimWe aimed to prospectively validate the Good Outcome Following Attempted Resuscitation (GO-FAR) score, which predicts the likelihood of survival to discharge neurologically intact or with minimal deficits (conscious, alert, and able to work) after in-hospital cardiac arrest (IHCA). MethodsInpatients experiencing an index episode of IHCA between 2010 and 2016 in hospitals participating in the Get With the Guidelines® — Resuscitation (GWTG-R) Registry were included. The score’s performance was prospectively validated in both all GWTG-R hospitals and in a subset of hospitals not part of the GWTG-R registry when the score was originally developed using prospective data. Score performance was stratified by hospital size, presence of residency training programs, and type of hospital ownership. Discrimination was measured by the c-statistic, calibration using a Hosmer-Lemeshow plot, and classification accuracy by the survival rates in each risk group. ResultsA total of 62,131 inpatients in 386 hospital were included. The GO-FAR score had similar discrimination (c-statistic 0.75, 95% CI 0.748−0.758), calibration, and classification accuracy as in the original study. Survival rates were somewhat higher due to a secular increase in survival of IHCA. In hospitals that were not part of the derivation population, the score performed as well as in the hospitals used to derive the score (c-statistic 0.75). The score performed similarly in hospitals of different sizes (c-statistic of 0.80 and 0.75 for hospital with ≤100 and >100 beds, respectively), with and without residency training programs (c-statistics of 0.76 and 0.75, respectively), and with different ownership structures (c-statistic of 0.79 for private, 0.74 for military government, and 0.76 for nonprofit hospital). ConclusionsThe GO-FAR score accurately classifies patients into risk groups based on their likelihood of survival to discharge with a good neurologic outcome following an episode of IHCA. Recalibration may be necessary using different point score cutoffs as IHCA survival increases.

Notfallversorgung in Pflegeeinrichtungen in der Stadt Braunschweig: Ein sektorenübergreifender Blick anhand von Kennzahlen aus Sterbefällen, Reanimationen, Krankenhauszuweisungen und Rettungsdiensteinsätzen

IntroductionGeneral survey of emergency care in nursing homes in the City of Braunschweig. MethodsRetrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). Results30 nursing homes with 3,100 beds (mean: 103; range: 35–250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4–1.6); emergency department visits per bed 1.4 (0.7–3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41–96 %); deaths per bed 0,29 (0.12–0.48); rate of deaths in hospital 46 % (0–62 %); CPRs per 1,000 beds 6.1 (0–28); CPR failure rate 22 (0–83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0–1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. ConclusionCompared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.

Outcome after pre-hospital cardiac arrest in accordance with underlying cause

AimIn terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. MethodsAll pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form ‘further clinical treatment’ of >30% were included, this resulted in a total return rate of 84% of the included data. ResultsIn total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication). ConclusionThe most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.

Association Between Hospital Recognition for Resuscitation Guideline Adherence and Rates of Survival for In-Hospital Cardiac Arrest.

Background Hospitals participating in the national Get With The Guidelines-Resuscitation registry receive an award for high rates of adherence to quality metrics for in-hospital cardiac arrest. We sought to evaluate whether awards based on these quality metrics can be considered a proxy for performance on cardiac arrest survival. Methods and Results Among 195 hospitals with continuous participation in Get With The Guidelines-Resuscitation between 2012 and 2015, we identified 78 that received an award (Gold or Silver) for ≥85% compliance for all 4 metrics for in-hospital cardiac arrest-time to chest compressions, ≤1 minute; time to defibrillation, ≤2 minutes; device confirmation of endotracheal tube placement; and a monitored/witnessed arrest-for at least 12 consecutive months during 2014 to 2015. Award hospitals had higher cardiac arrest volumes than nonaward hospitals but otherwise had similar site characteristics. During 2014 to 2015, award hospitals had higher rates of return of spontaneous circulation for in-hospital cardiac arrest than nonaward hospitals (median [interquartile range], 71% [64%-77%] versus 66% [59%-74%]; Spearman ρ, 0.19; P=0.009). However, rates of risk-standardized survival to discharge at award hospitals (median, 25% [interquartile range, 22%-30%]) were similar to nonaward hospitals (median, 24% [interquartile range, 12%-27%]; Spearman ρ, 0.13; P=0.06). Among hospitals in the best tertile for survival to discharge in 2014 to 2015, 55.4% (36/65) did not receive an award, with poor discrimination of high-performing hospitals by award status (C statistic, 0.53). Similarly, there was only a weak association between hospitals' award status in 2014 to 2015 and their rates of survival to discharge in the preceding 2-year period (Spearman ρ, 0.16; P=0.03). Conclusions The current recognition mechanism within a national registry for in-hospital cardiac arrest captures hospital performance on return of spontaneous circulation but is not well correlated with survival to discharge. This suggests that current awards for resuscitation quality may not adequately capture hospital performance on overall survival-the outcome of greatest interest to patients.

Guideline removal of atropine and survival after adult in-hospital cardiac arrest with a non-shockable rhythm

AimTo determine whether the removal of atropine from the 2010 ACLS guidelines for non-shockable cardiac arrests was associated with a change in survival. MethodsUsing 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. ResultsWe 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. ConclusionsThe removal of atropine from the 2010 guidelines was not associated with a significant change in survival.

Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: A retrospective analysis of the German Resuscitation Registry.

BackgroundCardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR).MethodsIn a retrospective analysis of the German Resuscitation Registry between 2007–2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices’ application on ROSC for epidemiological factors and therapeutic measures.ResultsWe included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2–54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4–41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48–2.12). Duration of CPR is a key determinant for achieving ROSC.ConclusionsMechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians’ decision, especially during prolonged resuscitation.

Introducing the Crimean out-of-hospital cardiac arrest and resuscitation registry (COHCARR): Rationale, design and 6-month baseline data

Introduction: There is an urgent unmet need for establishing out-of-hospital cardiac arrest (OHCA) registries in the former Soviet Union countries. This article aims to provide a rationale and describe methodology of the Crimean out-of-hospital cardiac arrest and resuscitation registry (COHCARR), and report baseline information on OHCA epidemiology and emergency medical service (EMS) performance in the Republic of Crimea. Methods: COHCARR is designed to be a prospective population-based registry of all EMS-attended OHCA cases with resuscitation attempts, occurring in the Republic of Crimea. The population coverage is 1.91 million (100% inhabitants of the republic). The baseline descriptive analysis of OHCA with attempted resuscitation (January 01-June 30, 2018) has been performed following the Utstein methodology to provide a snapshot of OHCA problem in the region. Results: During the period, a total of 6,391 OHCA were attended by EMS. With that, resuscitation was attempted only in 196 cases (3.1%; median age 65 years, male 56%, shockable 16%). Most (95%) were witnessed by EMS or a bystander. Out of the bystander-witnessed cases (24%, n=47), bystander resuscitation was attempted in 19% (n=9). Return of spontaneous circulation (ROSC) was achieved in 6.6% patients, and 5.6% survived to hospital admission. Conclusions: The low rates of attempted resuscitation, ROSC and survival to hospital admission imply an opportunity to improve outcomes from OHCA in the Crimea. The registry will help to target reasonable cost-effective interventions and assess their effectiveness in the region. COHCARR may serve as a basic model for developing OHCA registries in other post-Soviet territories.

Surveying the Literature

Surveying the Literature

Abstract 154: Guideline Removal of Atropine and Survival After Adult In-Hospital Cardiac Arrest With Non-Shockable Rhythms

Introduction: Atropine was removed from the 2010 American Heart Association’s Advanced Cardiac Life Support guidelines as routine management of non-shockable cardiac arrest, although the evidence to support or refute the use of atropine is lacking. In a previous study, atropine usage was shown to subsequently decline markedly. Whether removing atropine from the guidelines has affected survival remains unknown. Methods: Using the Get With The Guidelines®-Resuscitation registry, we included adult patients with an index in-hospital cardiac arrest between 2006-2015. Non-shockable and shockable cardiac arrest patients with high vs. low propensity score to receive atropine were separated into two cohorts. An interrupted time-series analysis was used to compare survival before (pre-exposure) and after (post-exposure) 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. Results: We included 21,822 non-shockable and 4,268 shockable cardiac arrests. Patient characteristics were similar between the pre-exposure and post-exposure period. Atropine was used for 9,170 (86%) non-shockable and 733 (34%) shockable cardiac arrests in the pre-exposure period and 3,903 (35%) non-shockable and 339 (16%) shockable cardiac arrests in the post-exposure period. The change over time in survival from the pre-exposure to the post-exposure period was not significantly different for the non-shockable compared to the shockable cohort (mean difference: 2.0% [95%CI: -0.7, 4.6] per year, p = 0.15, Figure). The immediate change in survival after introducing the guidelines was also not different between the cohorts (mean difference: 3.9% [95%CI: -2.2, 10], p = 0.21, Figure). Conclusions: The removal of atropine from the 2010 guidelines was not associated with a change in survival in our analysis.

Abstract 180: Nursing Roles for In-Hospital Cardiac Arrest Response: A Qualitative Study

Introduction: Survival and favorable clinical outcomes for in-hospital cardiac arrest (IHCA) are highly dependent on a skilled resuscitation team, prompt initiation of high quality CPR and defibrillation, and organizational structures to support resuscitation care. While nurses are generally involved in resuscitation efforts, the purpose of this study was to examine their specific roles and factors that affect their contributions during an IHCA response. Methods: We conducted a qualitative study at 9 hospitals participating in the AHA Get-With-The-Guidelines Resuscitation registry. Purposeful sampling was used to select hospitals that vary in terms of geography, academic status, and risk-standardized IHCA survival. Participants included nurses, physicians, respiratory therapists, pharmacists, quality improvement staff, hospital administrators, and other staff, yet discussion of the nursing function was prominent across all stakeholder groups. Qualitative thematic text analysis was used to identify the distinct types of nursing roles in relation to IHCA and how these roles were supported across sites. Results: We conducted semi-structured interviews with 158 individuals at 9 hospitals. Nurses were identified as an integral part of the IHCA response at all sites, with three major IHCA nursing roles identified: bedside first responder, rapid response or code team member, and leader. There were distinct differences across sites in support for nurses in these different roles with regard to educational training and competency, organizational engagement, and empowerment (Table). Conclusion: Nurses are a critical component of effective IHCA response and processes, including diverse roles as bedside first responders, code team members, and leadership for resuscitation care. Mentoring and empowering frontline nurses and ensuring that clinical competency and training needs for IHCA care specific for nurses is essential for resuscitation care.

Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States

Introduction: Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States. Methods: Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (&gt;18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events. Results: There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases. Conclusions: Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.