Resuscitation Quality in the ICU: A Retrospective Analysis

Area of Science:

• Critical Care Medicine
• Cardiology
• Health Quality Improvement

Background:

• The American Heart Association has established quality metrics for cardiopulmonary resuscitation, including timely administration of epinephrine and defibrillation, and correct airway device placement.
• Adherence to these critical care standards is vital for improving patient outcomes during cardiac arrest.
• This study investigates adherence trends and predictors of failure to meet these resuscitation quality metrics in Intensive Care Units (ICUs).

Purpose of the Study:

• To assess the adherence rates to specific American Heart Association resuscitation quality metrics within the ICU setting.
• To identify factors associated with the failure to adhere to time to epinephrine administration (≤ 5 min), time to defibrillation (≤ 2 min), and confirmation of tracheal airway device placement.
• To analyze trends in adherence to these quality metrics over time in adult ICUs.

Main Methods:

• A retrospective analysis was conducted using data from the Get With The Guidelines-Resuscitation registry.
• Adult patients experiencing an index cardiac arrest in US ICUs between 2006 and 2018 were included.
• Modified Poisson regression with generalized estimation equations was employed to analyze adherence and identify predictors.

Main Results:

• Adherence to time to epinephrine (≤ 5 min) increased from 93% to 98%, and confirmation of airway device placement increased from 93% to 97% between 2006 and 2018.
• Adherence to time to defibrillation (≤ 2 min) showed a modest increase from 72% to 75%.
• Failure to adhere to epinephrine and defibrillation metrics was associated with nonwitnessed arrests, nonmonitored status, nighttime arrests, noncardiac or traumatic illness categories, and renal insufficiency.

Conclusions:

• Overall adherence to American Heart Association resuscitation quality metrics in the ICU is high, particularly for epinephrine administration and airway management.
• Time to defibrillation within 2 minutes remains a challenge, with lower adherence rates compared to other metrics.
• Factors such as arrest circumstances and patient condition significantly influence adherence, indicating targeted interventions may be necessary to improve critical care resuscitation quality.