Early defibrillation: a key for successful outcome of in-hospital cardiac arrest.

BACKGROUND: The objectives of this study were to determine 1) the rate of delayed defibrillation and 2) the importance of early defibrillation in patients with cardiac arrest who need defibrillation in a large tertiary care hospital. MATERIAL AND METHOD: We analyzed data from Siriraj cardiopulmonary resuscitation (CPR) registry from January 2005 to December 2007. The registry recorded setting and cause of cardiac arrest, timing of cardiac arrest and time initiation of each step of treatment such as basic life support (BLS), advanced life support (ALS), defibrillation, medication, time of defibrillation. Outcome was recorded as return of spontaneous circulation (ROSC) which lasted at least 20 minutes and discharge from hospital. RESULTS: A total of 2160 in-hospital cardiac arrest records were sent to CPR center and were evaluated. 612 patients (28.3%) needed defibrillation. Average age was 57.1 +/- 21.2 years. Among patients who needed defibrillation, 250 patients (40.8) had early defibrillation. Median time to defibrillation after the detection of cardiac arrest was 8 (3, 15) minutes. Factors associated with delayed defibrillation were the patients being in non-intensive care unit (non-ICU) wards, being in wards without standby defibrillator, and female gender. 283 patients (46.2%) had ROSC after CPR and 50 patients (8.2%) survived to discharge from hospital. Time to defibrillation was the most important predictor for ROSC and survival to discharge. CONCLUSION: Among in-hospital patients with cardiac arrest and who needed defibrillation, early defibrillation is the major key to a successful outcome.