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Abstract：
To determine whether the removal of atropine from the 2010 ACLS guidelines for non-shockable cardiac arrests was associated with a change in survival.
Using the Get With The Guidelines®-Resuscitation registry, we included adults with an index in-hospital cardiac arrest between 2006 and 2015. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable functional outcome. An interrupted time-series analysis was used to compare survival before (pre-guidelines) and after (post-guidelines) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine.
We included 20,499 non-shockable and 3968 shockable cardiac arrests. Patient characteristics were similar between the pre-guidelines and post-guidelines period. Atropine was used for 8653 (87%) non-shockable and 680 (35%) shockable cardiac arrests in the pre-guidelines period and 3643 (35%) non-shockable and 320 (16%) shockable cardiac arrests in the post-guidelines period. The change over time in survival from the pre-guidelines to the post-guidelines period was not significantly different for the non-shockable compared to the shockable cohort (risk difference: 2.0% [95%CI: -0.8, 4.8] per year, p = 0.17). The immediate change in survival after introducing the guidelines was also not different between the cohorts (risk difference: 3.5% [95%CI: -2.6, 9.7], p = 0.26). Results were similar for the secondary outcomes and in multiple sensitivity analyses.
The removal of atropine from the 2010 guidelines was not associated with a significant change in survival.
Using the Get With The Guidelines®-Resuscitation registry, we included adults with an index in-hospital cardiac arrest between 2006 and 2015. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable functional outcome. An interrupted time-series analysis was used to compare survival before (pre-guidelines) and after (post-guidelines) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine.
We included 20,499 non-shockable and 3968 shockable cardiac arrests. Patient characteristics were similar between the pre-guidelines and post-guidelines period. Atropine was used for 8653 (87%) non-shockable and 680 (35%) shockable cardiac arrests in the pre-guidelines period and 3643 (35%) non-shockable and 320 (16%) shockable cardiac arrests in the post-guidelines period. The change over time in survival from the pre-guidelines to the post-guidelines period was not significantly different for the non-shockable compared to the shockable cohort (risk difference: 2.0% [95%CI: -0.8, 4.8] per year, p = 0.17). The immediate change in survival after introducing the guidelines was also not different between the cohorts (risk difference: 3.5% [95%CI: -2.6, 9.7], p = 0.26). Results were similar for the secondary outcomes and in multiple sensitivity analyses.
The removal of atropine from the 2010 guidelines was not associated with a significant change in survival.
摘要：
为了确定从2010年ACLS指南中删除阿托品治疗不可电击心脏骤停是否与生存率的变化有关。
使用GetWithTheGuidelines®-Resuscitation注册表，我们纳入了2006年至2015年期间住院心脏骤停指数的成年人.主要结局是生存至出院。次要结果包括自发循环的恢复和有利的功能结果。使用中断时间序列分析来比较2010年指南引入之前（指南前）和之后（指南后）的生存率。使用差异差异方法来比较不可电击和可电击队列之间的中断时间序列结果，以解释与阿托品无关的指南变化。
我们包括20,499个不可电击的心脏骤停和3968个可电击的心脏骤停。在指南前和指南后期间，患者特征相似。阿托品在指南前用于8653（87％）不可电击和680（35％）可电击心脏骤停，在指南后用于3643（35％）不可电击和320（16％）可电击心脏骤停。与可电击队列相比，非电击队列从指南前到指南后的生存期随时间的变化没有显着差异（风险差异：每年2.0％[95CI：-0.8,4.8]，p=0.17）。引入指南后生存率的立即变化在队列之间也没有差异（风险差异：3.5％[95CI：-2.6,9.7]，p=0.26）。次要结局和多重敏感性分析的结果相似。
从2010年指南中删除阿托品与生存率的显著变化无关。
使用GetWithTheGuidelines®-Resuscitation注册表，我们纳入了2006年至2015年期间住院心脏骤停指数的成年人.主要结局是生存至出院。次要结果包括自发循环的恢复和有利的功能结果。使用中断时间序列分析来比较2010年指南引入之前（指南前）和之后（指南后）的生存率。使用差异差异方法来比较不可电击和可电击队列之间的中断时间序列结果，以解释与阿托品无关的指南变化。
我们包括20,499个不可电击的心脏骤停和3968个可电击的心脏骤停。在指南前和指南后期间，患者特征相似。阿托品在指南前用于8653（87％）不可电击和680（35％）可电击心脏骤停，在指南后用于3643（35％）不可电击和320（16％）可电击心脏骤停。与可电击队列相比，非电击队列从指南前到指南后的生存期随时间的变化没有显着差异（风险差异：每年2.0％[95CI：-0.8,4.8]，p=0.17）。引入指南后生存率的立即变化在队列之间也没有差异（风险差异：3.5％[95CI：-2.6,9.7]，p=0.26）。次要结局和多重敏感性分析的结果相似。
从2010年指南中删除阿托品与生存率的显著变化无关。
