000			04836nam a22007097a 4500
008			200131s20202020 xxu||||| |||| 00| 0 eng d
022			_a0149-2918
024			_a10.1016/j.clinthera.2019.11.001 [doi]
024			_aS0149-2918(19)30517-X [pii]
040			_aOvid MEDLINE(R)
099			_a31874777
245			_aFrequency of Advanced Cardiac Life Support Medication Use and Association With Survival During In-hospital Cardiac Arrest.
251			_aClinical Therapeutics. 42(1):121-129, 2020 01.
252			_aClin Ther. 42(1):121-129, 2020 01.
252			_zClin Ther. 2019 Dec 21
253			_aClinical therapeutics
260			_c2020
260			_fFY2020
265			_saheadofprint
265			_sppublish
266			_d2020-01-31
268			_aClinical Therapeutics. 2019 Dec 21
520			_aFINDINGS: Criteria were met for 181 IHCA events. Demographic characteristics were 71% black, 17% white, mean age of 65 years, and 46% women. Epinephrine was given in 86.7% of the arrests, with a mean cumulative dose of 4.2 mg. Sodium bicarbonate was given in 63.5% of the arrests, with a mean cumulative dose of 9.0 g (1.9 amps). Amiodarone was given in 30.9% of the arrests, with a mean cumulative dose of 311.8 mg. Median time to defibrillation was 2 min (interquartile range, 1-4 min). Preexisting ESRD was present in 24.8% of patients, of whom 71.1% received sodium bicarbonate. Sodium bicarbonate administration was associated with a lower likelihood of survival to discharge (odds ratio [OR] = 0.27; 95% CI, 0.11-0.66) as well as a lower rate of return to spontaneous circulation (ROSC) (OR = 0.35; 95% CI, 0.13-0.95). Magnesium administration was associated with a lower rate of ROSC (OR = 0.39; 95% CI, 0.15-0.98). Of note, in patients with preexisting ESRD, no medications were significantly associated with a change in likelihood of survival to discharge or rate of ROSC. In patients without preexisting ESRD, magnesium was associated with a lower rate of ROSC (OR = 0.23; 95% CI, 0.08-0.77).
520			_aIMPLICATIONS: We found that in a hospital with established rapid response and code blue teams, numerous medications that are not recommended for routine use in cardiac arrest are still administered at significant frequencies. Furthermore, substantial amounts of drugs with known recent shortage are used in IHCA. Inc. Copyright (c) 2019 Elsevier Inc. All rights reserved.
520			_aMETHODS: This retrospective, single-center, medical record review was performed at a large, urban teaching hospital. Adults >=18 years old who had an IHCA with confirmed loss of pulse between January 2017 and March 2018 were identified. A standardized data collection tool was used to extract data from the electronic medical record. The primary outcome was the frequency and quantity of medications used during the IHCA. Secondary outcomes included median time to defibrillation and frequency of sodium bicarbonate use, including among patients with end-stage renal disease (ESRD).
520			_aPURPOSE: Cardiopulmonary resuscitation is common in the United States, with >200,000 people experiencing an in-hospital cardiac arrest (IHCA) annually. Recent medication shortages have raised the question of the frequency and type of medication used during cardiac arrest resuscitation. We sought to determine the frequency and quantity of medications used during IHCA.
546			_aEnglish
650			_a*Advanced Cardiac Life Support/sn [Statistics & Numerical Data]
650			_a*Amiodarone/tu [Therapeutic Use]
650			_a*Anti-Arrhythmia Agents/tu [Therapeutic Use]
650			_a*Epinephrine/tu [Therapeutic Use]
650			_a*Heart Arrest/mo [Mortality]
650			_a*Heart Arrest/th [Therapy]
650			_a*Sodium Bicarbonate/tu [Therapeutic Use]
650			_aAged
650			_aAged, 80 and over
650			_aDrug Utilization/sn [Statistics & Numerical Data]
650			_aElectric Countershock
650			_aFemale
650			_aHospitals, Teaching
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aOdds Ratio
650			_aPatient Discharge
650			_aUnited States
651			_aMedStar Washington Hospital Center
656			_aEmergency Medicine
656			_aMedical Director
656			_aMedicine/Nephrology
656			_aNursing
657			_aJournal Article
700			_aBrenner, Nicole
700			_aDubin, Jeffrey S
700			_aGoyal, Munish
700			_aHeinrichs, Dorothy
700			_aTitus, Sheryl
700			_aWilson, Matthew
790			_aAhn J, Benz P, Brenner N, Chong S, Dubin J, Goyal M, Heinrichs D, Titus S, Wilson M, Woo S
856			_uhttps://dx.doi.org/10.1016/j.clinthera.2019.11.001 _zhttps://dx.doi.org/10.1016/j.clinthera.2019.11.001
942			_cART _dArticle
999			_c4894 _d4894