Abstract
BackgroundIncidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21–30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.MethodsWe conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.ResultsThe cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status.ConclusionsThe in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).
Highlights
The incidence of in-hospital cardiac arrests (IHCAs) has been reported to be from 0.78 to 4.60 per 1000 patient admissions [1,2,3,4,5,6,7]
As well as local implementation of international resuscitation recommendations [15] and guidelines [13, 14], potential key factors that influence successful in-hospital resuscitation include: (1) a focus on prevention and early recognition of cardiac arrest, with immediate start of basic life support (BLS) [16]; (2) immediate activation of emergency responses to IHCAs, to provide early high-quality advanced life support (ALS) [17]; (3) a high-performing hospital-wide rapid response system consisting of a cardiac arrest team and/or medical emergency team that are organised, well trained, and available 24 h per day, 7 days a week [18,19,20,21]; (4) state-of-the-art post-resuscitation care [22]; (5) performance-driven debriefings [23, 24]; and (6) recording of the institution resuscitation success, with reporting of the results
Our findings address the gap in knowledge regarding (1) a large proportion of the Swiss population, (2) the reasons behind the “weakest links” in the chain of survival in this population, and (3) data on functional outcomes and health-related quality of life of cardiac arrest survivors over five years
Summary
The incidence of in-hospital cardiac arrests (IHCAs) has been reported to be from 0.78 to 4.60 per 1000 patient admissions [1,2,3,4,5,6,7]. As well as local implementation of international resuscitation recommendations [15] and guidelines [13, 14], potential key factors that influence successful in-hospital resuscitation include: (1) a focus on prevention and early recognition of cardiac arrest, with immediate start of basic life support (BLS) [16]; (2) immediate activation of emergency responses to IHCAs, to provide early high-quality advanced life support (ALS) [17]; (3) a high-performing hospital-wide rapid response system consisting of a cardiac arrest team and/or medical emergency team that are organised, well trained, and available 24 h per day, 7 days a week [18,19,20,21]; (4) state-of-the-art post-resuscitation care [22]; (5) performance-driven debriefings [23, 24]; and (6) recording of the institution resuscitation success, with reporting of the results. Our aim was to record all cardiac arrest team interven‐ tions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests
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