Lakeland Regional Health Medical Center Valrico, Florida, USA
Introduction: Cardiac arrests are life-threatening conditions occurring approximately 9-10 times per 1000 hospital admissions. The initial treatment of cardiac arrest consists of basic resuscitative principles: shock shockable rhythms, perform high-quality cardiopulmonary resuscitation (CPR), and administer recommended medications including epinephrine. The 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend administering epinephrine “after initial defibrillation attempts have failed” in patients with shockable rhythms. A study be Evans et al demonstrated a failure to administer defibrillations prior to epinephrine was associated with worse survival. Our study evaluated the rate of epinephrine administered before defibrillation in patients with initial shockable rhythms prior to education and compared them to the rate post- education.
Methods: This was a single center, retrospective cohort evaluation of patients with in-hospital cardiac arrests in an 892-bed, comprehensive tertiary referral hospital. All patients suffered a cardiac arrest defined as a pulseless rhythm requiring either CPR or defibrillation in an acute care area. Patients were divided into two groups, the pre-education group (Jan-May 2023) and the post-education group (Jan-May 2024). The primary outcome was the rate of epinephrine administration prior to defibrillation in initial shockable rhythms before education compared to after education.
Results: There were 108 categorized codes with 14 (13%) having an initial shockable rhythm in the pre-education group while 162 codes with 21 (13%) initial shockable rhythms were in the post-education group. The two groups were similar in the number of codes with shockable rhythms originating in the ICU (71% vs. 71%), those that obtained ROSC (86% vs. 86%), and ultimately expired (43% vs 43%). There was a reduction in the number of patients who received epinephrine prior to defibrillation in the post educations group vs pre-education (19% vs. 50%, respectively).
Conclusions: Education provided to the code response teams may improve guideline compliance by prioritizing defibrillation over epinephrine administration in patients with initial shockable rhythms.
