Resuscitation Quality in the ICU: A Retrospective Analysis

Background: American Heart Association quality metrics of resuscitation include time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of airway device placement in trachea. This study examined trends in adherence to these quality metrics in the ICU and identified predictors of failure to adhere to these metrics. Research Question: What is the registered adherence to time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of airway device placement in trachea in the ICU setting? Study Design and Methods: This was a retrospective analysis. Using the Get With The Guidelines-Resuscitation registry, adult patients with an index cardiac arrest in adult ICUs between 2006 and 2018 in the United States were identified. Modified Poisson regression with generalized estimation equations were used for the analyses. Results: A total of 97,009 adult ICU patients from 538 hospitals were identified using the Get With The Guidelines-Resuscitation registry, and 75,668 patients were included in the final analysis. From 2006 to 2018, adherence to time to epinephrine ≤ 5 min increased from 93% (95% CI, 93-94) to 98% (95% CI, 97-98), time to defibrillation ≤ 2 min increased from 72% (95% CI, 69-75) to 75% (95% CI, 72-78), and confirmation of airway device placement in trachea increased from 93% (95% CI, 91-94) to 97% (95% CI, 96-98). Nonwitnessed status (P <.001), nonmonitored status (P =.003), and nighttime arrest (P =.002) were associated with adherence failure for time to epinephrine ≤ 5 min, whereas a noncardiac (P <.001) or traumatic (P <.001) illness category, renal insufficiency (P =.001), and nighttime arrest (P =.03) were associated with adherence failure for time to defibrillation ≤ 2 min. Interpretation: Overall, quality metric adherence was high in the ICU, with the exception of time to defibrillation ≤ 2 min.