Not surprising, of course, but an interesting analysis of a large data set.
The authors pulled 108,636 in-hospital cardiac arrest cases out of the National Registry of Cardiopulmonary Resuscitation and evaluated them for “errors” – such as multiple intubation attempts, incorrect medication administration, delays in code team activation, etc. After attempting to control for all the differences (of which there were many) in level of care and type of patient suffering cardiac arrest, they finally find that any documented error in resuscitation led to a 9.9% increase in adjusted hazard ratio for death in non-VF/pVT, and a 34.2% increase in VF/pVT patients.
Specifically, when they break out the different types of errors, essentially all the effect size was related to delays in medication administration for non-VF/pVT, and delays in medication and failure to defibrillate in VF/pVT.
“Impact of resuscitation system errors on survival from in-hospital cardiac arrest”
www.ncbi.nlm.nih.gov/pubmed/21963583
What I find funny about this is that people seem to be falling over each other to talk about how ACLS medications, including Epinephrine (presumably the "vasoconstrictor" they are referring to in the abstract), are uniformly useless these days. At least the evidence seems to be absent for benefit. Now this study seems to blame bad outcomes on delay in medication administration, specifically bringing up vasoconstrictors in the first 5 minutes. I love cognitive dissonance, but, hello?