title: Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study).
abstract: Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p <0.001). The proportion of patients who died during the arrest was 12.5% in those who received epinephrine alone, 30.0% in those who received only epinephrine and bicarbonate, and 46.7% to 57.9% in the remaining groups. Patients receiving only epinephrine had shorter resuscitation durations compared to that of the other groups (p <0.001) and improved survival (p = 0.003). In conclusion, providers frequently use nonguideline medications in resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Snipelisky.david@mayo.edu.
authors.forename: David
authors.initials: D
authors.lastname: Snipelisky
authors.affiliation: Division of Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Jordan
authors.initials: J
authors.lastname: Ray
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Gautam
authors.initials: G
authors.lastname: Matcha
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Archana
authors.initials: A
authors.lastname: Roy
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Adrian
authors.initials: A
authors.lastname: Dumitrascu
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Dana
authors.initials: D
authors.lastname: Harris
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Veronica
authors.initials: V
authors.lastname: Bosworth
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Brooke
authors.initials: B
authors.lastname: Clark
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida.
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Thomas
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Tyler
authors.initials: T
authors.lastname: Vadeboncoeur
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida.
authors.forename: Fred
authors.initials: F
authors.lastname: Kusumoto
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: M Caroline
authors.initials: MC
authors.lastname: Burton
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004338:Drug Combinations; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013686:Telemetry / Q000379:methods*
chemical_list: D000316:Adrenergic alpha-Agonists; D001639:Bicarbonates; D004338:Drug Combinations; D002118:Calcium; D004837:Epinephrine