Evaluation of Medication Use and Outcomes in Patients Suffering an In-Hospital Cardiac Arrest

Abstract

Objectives: There is limited information regarding medication use during in-hospital cardiac arrest (IHCA). The purpose of this study was to characterize medication use during IHCA, and determine the association between medications used and survival to hospital discharge. Methods: This was a retrospective cohort study conducted in an academic medical center looking at IHCA between October 2009 and December 2013. Data regarding medication use during IHCA and other pertinent predictors of survival were collected. The primary objective was to characterize medications used during IHCA and to assess the relationship between medications used and survival to hospital discharge. Results: There were 171 patients who were included in the study and 44 (26%) survived to hospital discharge. The medications most commonly used were epinephrine, sodium bicarbonate, calcium chloride or gluconate, atropine, amiodarone, vasopressin, magnesium sulfate, and lidocaine. Patients who died were more likely to receive total epinephrine ≥3 mg (53% versus 27%, p=0.005), sodium bicarbonate (73% versus 55%, p=0.025), and calcium (59% versus 27%, p<0.001), compared to survivors, respectively. After adjusting for duration of resuscitation, total epinephrine ≥3 mg (OR 0.38, 95% CI 0.18 to 0.83, p=0.015) and calcium (OR 0.30, 95% CI 0.14 to 0.64, p=0.002) was associated with decreased survival. Conclusions: This study found that 3 mg or more of epinephrine, calcium salts and sodium bicarbonate are linked to decreased survival to hospital discharge. Further research should be done to define the cause of this link.