(1404) Impact of a Visual Alert on the Timing of Epinephrine Administration in Shockable Cardiac Arrest

Introduction: Early defibrillation is critical to survival when a cardiac arrest is caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT). Epinephrine is associated with worse outcomes when given prior to two shocks in shockable rhythms. Two propensity matched analyses were recently published and found that early administration of epinephrine was associated with lower odds of survival and return of spontaneous circulation (ROSC). A visual alert in the emergency medication trays was implemented to decrease the use of epinephrine prior to two shocks for PVT/VF arrest.

Methods: This study was a single-center retrospective review of all patients with a cardiac arrest due to an initial shockable rhythm treated with defibrillation, one year prior to implementation of the visual alert compared to patients one year after implementation of the alert. The study population included patients who were at least 18 years old and had an index in-hospital cardiac arrest due VF or PVT. Patients who did not receive any defibrillation or epinephrine and patients with missing data on timing of defibrillation or epinephrine were excluded. The primary outcome was incidence of early epinephrine use before and after alert implementation. Secondary outcomes included time to first shock, survival to discharge, ROSC and neurological disability using the cerebral performance category scores between the two groups.

Results: Twelve patients were in before alert implementation group, and there were 20 patients in the post alert implementation group. Early epinephrine was administered to 38% of PVT/VF patients before alert implementation. Five percent of PVT/VF patients received early epinephrine after alert implementation (P=0.015). Average time to defibrillation decreased from 2.4 minutes to 1.6 minutes after alert implementation (P=0.21). Median time to defibrillation was 2 minutes before alert implementation versus 1.5 minutes after alert implementation. There was no statistical difference in survival to discharge, ROSC and neurological disability.

Conclusions: A visual alert significantly decreased use of early epinephrine in PVT/VF arrest and showed a potential decrease in time to first shock. A simple process improvement project led to improvement in desired cardiac arrest procedural parameters.