Thursday, January 3, 2008

Study Finds that Hospital Delays in Defibrillation Increase Likelihood of Death

On January 3, 2008, the New York Times reported that a recent  study in the New England Journal of Medicine reveals that hospital delays in defibrillation increases the likelihood of death of cardiac patients.  Here is the abstract of the study:

Background Expert guidelines advocate defibrillation within 2 minutes after an in-hospital cardiac arrest caused by ventricular arrhythmia. However, empirical data on the prevalence of delayed defibrillation in the United States and its effect on survival are limited.

Methods We identified 6789 patients who had cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. Using multivariable logistic regression, we identified characteristics associated with delayed defibrillation. We then examined the association between delayed defibrillation (more than 2 minutes) and survival to discharge after adjusting for differences in patient and hospital characteristics.

Results The overall median time to defibrillation was 1 minute (interquartile range, <1 to 3 minutes); delayed defibrillation occurred in 2045 patients (30.1%). Characteristics associated with delayed defibrillation included black race, noncardiac admitting diagnosis, and occurrence of cardiac arrest at a hospital with fewer than 250 beds, in an unmonitored hospital unit, and during after-hours periods (5 p.m. to 8 a.m. or weekends). Delayed defibrillation was associated with a significantly lower probability of surviving to hospital discharge (22.2%, vs. 39.3% when defibrillation was not delayed; adjusted odds ratio, 0.48; 95% confidence interval, 0.42 to 0.54; P<0.001). In addition, a graded association was seen between increasing time to defibrillation and lower rates of survival to hospital discharge for each minute of delay (P for trend <0.001).

Conclusions Delayed defibrillation is common and is associated with lower rates of survival after in-hospital cardiac arrest.

Interestingly, the article reports that "being black also increased the odds of a delay, but the researchers said this finding probably reflected the quality of hospitals in areas where most blacks live and are treated, rather than a decision by medical workers to drag their feet because of a patient’s race."  For the full article, see "Hospitals Slow in Heart Cases, Research Finds" in the NYT.  For the full study, see "Delayed Time to Defibrillation after In-Hospital Cardiac" in the New England Journal of Medicine.


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