Abstract 10975: National Study of In-Hospital Cardiac Arrest in the Emergency Department, 2010-2018

Abstract

Introduction: Little is known about in-hospital cardiac arrest (IHCA) in the U.S. emergency department (ED). This study aimed to describe the incidence and mortality of ED-based IHCA visits and to investigate factors associated with higher incidence and poor outcome of IHCA. Hypothesis: We hypothesized that ED-based IHCA contributes to a stable proportion of ED visits and remains a higher mortality rate after the event. Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010 to 2018. Adult ED visits with IHCA were identified using the cardiopulmonary resuscitation code, excluding those with out-of-hospital cardiac arrest. Analysis used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design. Results: Over the 9-year study period, there was an estimated 1,114,000 ED visits with IHCA and the proportion of IHCA visits in the entire ED population (1.8 per 1,000 ED visits) appeared stable. The mean age of the IHCA visits was 60 years, and 65% were men. Older age, male sex, arrival by ambulance, and being uninsured independently predicted a higher incidence of ED-based IHCA. About 51% of ED-based IHCA died in the ED, and the trend remained stable. Arrival by ambulance, nighttime or weekend arrival, and being in the non-Northeast location were independently associated with a higher mortality rate after IHCA. Conclusions: The high burden of ED visits with IHCA persisted and the outcome remained poor. Some patients were disproportionately affected and certain contextual factors were associated with a poorer outcome.