A descriptive analysis of the relationship between vasopressor administration and return of spontaneous circulation during inpatient cardiopulmonary arrest

• Restricted to UC San Diego use only

• 2011

• Altieri, Katharine

Cardiopulmonary arrest remains a leading cause of morbidity and mortality in North America. Despite a renaissance in our understanding of the pathophysiology and optimal therapy, reported survival remains low from both inpatient and out-of-hospital arrest. Resuscitation science is undergoing changes, with a rapid expansion of our understanding of the physiology of resuscitation, in addition to a substantial increase in outcomes-based studies to guide therapeutic interventions. Epinephrine and vasopressin have been the most commonly studied and utilized vasopressors in cardiac arrests. Despite animal studies suggesting improved outcomes in experimental cardiac arrest, clinical trials of pressor agents have failed to show clear cut benefit from either vasopressin or epinephrine. However, there is evidence that the use of vasopressor agents favor initial return of spontaneous circulation (ROSC), which should improve perfusion to vital organs and therefore patient outcomes. This study examines the use of combined vasopressin and epinephrine administration versus epinephrine alone during inpatient cardiac arrests as predictors of ROSC and survival to discharge. UCSD's original resuscitation protocol along with the novel Advanced Resuscitation Training (ART) program, uses a strategy of continuous compressions, a filtered ECG to allow for rhythm analysis without pausing compressions, end-tidal carbon dioxide as a surrogate for assessing ROSC, and frequent code review with feedback provided for program improvement. The ART continuous compression mandate differs from the Advanced Cardiac Life Support (ACLS) 2005 guidelines by the American Heart Association which recommends pausing compressions to provide ventilations and every two minutes to assess for ROSC. UCSD's ART program and original resuscitation protocol provide a unique opportunity that allows the moment of ROSC to be more accurately identified, making this analysis feasible. This retrospective study on the relationship between vasopressor administration and outcomes encompasses inpatient cardiac arrests from July 2005 through June 2009. This data set is also being used in another primary analysis of the overall effectiveness of the ART program by comparing outcomes before and after its implementation. Each of these efforts combine clinical and performance-improvement data that will further refine treatment protocols and inpatient processes

1 online resource (13 p.)

• Academic Dissertations

• Dissertations, Academic--School of Medicine. (Discipline)--UCSD

• text

Thesis (M.D.)--University of California, San Diego, 2011

Forms part of the UCSD School of Medicine independent study projects, Class of 2011

Includes bibliographical references (p. 4-6)

• Katharine Altieri

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2020-10-22