Delayed time to defibrillation after intraoperative and periprocedural cardiac arrest.
BACKGROUND
Delay in defibrillation (more than 2 min) is associated with worse survival in patients with a cardiac arrest because of ventricular fibrillation or pulseless ventricular tachycardia in intensive care units and inpatient wards.


METHODS
We tested the relationship between delayed defibrillation and survival from intraoperative or periprocedural cardiac arrest, adjusting for baseline patient characteristics. The analysis was based on data from 865 patients who had intraoperative or periprocedural cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia in 259 hospitals participating in the National Registry of Cardiopulmonary Resuscitation.


RESULTS
The median time to defibrillation was less than 1 min (interquartile range, <1 to 1 min). Delays in defibrillation occurred in 119 patients (13.8%). Characteristics associated with delayed defibrillation included pulseless ventricular tachycardia and noncardiac admitting diagnosis. The association between delayed defibrillation and survival to hospital discharge differed for periprocedural and intraoperative cardiac arrests (P value for interaction = 0.003). For patients arresting outside the operating room, delayed defibrillation was associated with a lower probability of surviving to hospital discharge (31.6% vs. 62.1%, adjusted odds ratio 0.49; 95% CI 0.27, 0.88; P = 0.018). In contrast, delayed defibrillation was not associated with survival for cardiac arrests in the operating room (46.8% vs. 39.6%, adjusted odds ratio 1.23, 95% CI 0.70, 2.19, P = 0.47).


CONCLUSIONS
Delays in defibrillation occurred in one of seven cardiac arrests in the intraoperative and periprocedural arenas. Although delayed defibrillation was associated with lower rates of survival after cardiac arrests in periprocedural areas, there was no association with survival for cardiac arrests in the operating room.
Mhyre
Jill M
JM
Department of Anesthesiology, The University of Michigan Health System, Ann Arbor, Michigan, USA. jmmhyre@umich.edu
Ramachandran
Satya Krishna
SK
Kheterpal
Sachin
S
Morris
Michelle
M
Chan
Paul S
PS
D000368:Aged; D016063:Blood Loss, Surgical; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D003422:Critical Care; D016208:Databases, Factual; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016134:Organizational Policy; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy