Abstract
ObjectiveTo determine changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest, from a countrywide perspective. MethodsPatient information from the Swedish Registry for Cardiopulmonary Resuscitation was analysed in relation to monitoring level of ward and initial rhythm. The primary outcome was defined as survival at 30 days. Changes in survival and incidence of shockable rhythms were reported per year from 2008 to 2018. Also, epidemiological data were compared between two time periods, 2008–2013 and 2014–2018. ResultsIn all, 23,186 unique patients (38.6% female) were included in the study. The mean age was 72.6 (SD 13.2) years. Adjusted trends indicated an overall increase in 30-day survival from 24.7% in 2008 to 32.5% in 2018, (on monitoring wards from 32.5% to 43.1% and on non-monitoring wards from 17.6% to 23.1%). The proportion of patients found in shockable rhythms decreased overall from 31.6% in 2008 to 23.6% in 2018, (on monitoring wards from 42.5% to 35.8 % and on non-monitoring wards from 20.1% to 12.9%). Among the patients found in shockable rhythms, the proportion of patients defibrillated before the arrival of cardiac arrest team increased from 71.0% to 80.9%. ConclusionsIn an 11-year perspective, resuscitation in in-hospital cardiac arrest in Sweden was characterised by an overall increase in the adjusted 30-day survival, despite a decrease in shockable rhythms. An increased proportion, among the patients found in a shockable rhythm, who were defibrillated before the arrival of a cardiac arrest team may have contributed to the finding.
Highlights
A substantial proportion of deaths related to cardiac disease occur in hospitals
Among the patients found in shockable rhythms, the proportion of patients defibrillated before the arrival of cardiac arrest team increased from 71.0% to 80.9%
Among the patients found in a shockable rhythm, who were defibrillated before the arrival of a cardiac arrest team may have contributed to the finding
Summary
A substantial proportion of deaths related to cardiac disease occur in hospitals. The mortality rate in patients affected by cardiac arrest in healthcare units is high, and survival is strongly dependent on the location of the event within the hospital.[1,2] The survival rate of patients on wards with monitoring facilities can be up to twice as high as it is on wards without monitoring facilities.[3]. In a previous study conducted in a single tertiary hospital, we concluded that the treatment of in-hospital cardiac arrest (IHCA) was characterised by a more rapid start of treatment, over 20 years.[3] There was a significant increase in 30-day survival, from 44% to 56%, on wards with monitoring facilities. On wards without these facilities, there was a substantial decrease in shockable rhythms over time, from 46% to 26%. There is a knowledge gap with regard to changes in characteristics and outcome after IHCA on monitoring and non-monitoring wards in recent decades from a countrywide perspective
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