Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region

Abstract

Aimsto report the incidence, characteristics, and outcome of in-hospital cardiac arrest (IHCA) in a large Italian region. Settingall hospitals participating in the IHCA Registry Initiative of Piedmont. Methodsobservational cohort study in adult (>18year old) inpatients resuscitated from IHCA during three consecutive years (2012–2014). The main outcome measures were IHCA incidence and survival to hospital discharge. ResultsA total of1539 arrests in adult inpatients were recorded in the study period, yielding an overall incidence of 1.51 arrests/1000 admissions. The incidence was highest at day 1 after hospital admission and in the morning hours, with a peak at 9.00 a.m. Median age was 77 (interquartile range 68–83) years. The presenting rhythm was ventricular fibrillation/pulseless ventricular tachycardia in 291/1539 (18.9%) cases. A total of 549/1539 (35.7%) patients achieved recovery of spontaneous circulation (ROSC) and 228/1539(14.8%) survived hospital discharge, with 207 (90.8%) of the latter having good neurological outcome (Cerebral Performance Categories [CPC] 1 or 2).After adjustment for major confounders, a pre-arrest CPC=1, a cardiac cause of arrest, a shockable presenting rhythm, and a shorter duration of resuscitation were independently associated with a higher likelihood of survival to discharge. Conclusionsin this Italian registry the incidence of IHCA and its circadian distribution were comparable to those in the NCAA registry in the UK. Patients were older and had a lower ROSC rate than these observed in other large IHCA registries, but post-ROSC survival rate and factors affecting survival to discharge were similar.