Outcome Of In-hospital Cardiac Arrest Research Articles

Outcome of In-Hospital Cardiac Arrest among Patients with COVID-19: A Systematic Review and Meta-Analysis.

Outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19 have been reported by several small single-institutional studies; however, there are no large studies contrasting COVID-19 IHCA with non-COVID-19 IHCA. The objective of this study was to compare the outcomes following IHCA between COVID-19 and non-COVID-19 patients. We searched databases using predefined search terms and appropriate Boolean operators. All the relevant articles published till August 2022 were included in the analyses. The systematic review and meta-analysis were conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An odds ratio with a 95% confidence interval (CI) was used to measure effects. Among 855 studies screened, 6 studies with 27,453 IHCA patients (63.84% male) with COVID-19 and 20,766 (59.7% male) without COVID-19 were included in the analysis. IHCA among patients with COVID-19 has lower odds of achieving return of spontaneous circulation (ROSC) (OR: 0.66, 95% CI: 0.62-0.70). Similarly, patients with COVID-19 have higher odds of 30-day mortality following IHCA (OR: 2.26, 95% CI: 2.08-2.45) and have 45% lower odds of cardiac arrest because of a shockable rhythm (OR: 0.55, 95% CI: 0.50-0.60) (9.59% vs. 16.39%). COVID-19 patients less commonly underwent targeted temperature management (TTM) or coronary angiography; however, they were more commonly intubated and on vasopressor therapy as compared to patients who did not have a COVID-19 infection. This meta-analysis showed that IHCA with COVID-19 has a higher mortality and lower rates of ROSC compared with non-COVID-19 IHCA. COVID-19 is an independent risk factor for poor outcomes in IHCA patients.

A more conservative test of sex differences in the treatment and outcome of in-hospital cardiac arrest

BackgroundStudies investigating sex disparities related to treatment and outcome of in-hospital cardiac arrest (IHCA) have produced divergent findings and have typically been unable to adjust for outstanding confounding variables. ObjectivesThe aim was to examine sex differences in treatment and survival following IHCA, using a comprehensive set of control variables including e.g., age, comorbidity, and patient-level socioeconomic status. MethodsThis retrospective study was based on data from the Swedish Register of Cardiopulmonary Resuscitation and Statistics Sweden. In the primary analyses, logistic regression models and ordinary least square regressions were estimated. ResultsThe study included 24,217 patients and the majority (70.4%) were men. In the unadjusted analyses, women had a lower chance of survival after cardiopulmonary resuscitation (CPR) attempt, at hospital discharge (with good neurological function) and at 30 days (p<0.01). In the adjusted regression models, female sex was associated with a higher chance of survival after the CPR attempt (B = 1.09, p<0.01) and at 30-days (B = 1.09, p<0.05). In contrast, there was no significant association between sex and survival to discharge with good neurological outcome. Except for treatment duration (B=-0.07, p<0.01), no significant associations between sex and treatment were identified. ConclusionsNo signs of treatment disparities or discrimination related to sex were identified. However, women had a better chance of surviving IHCA compared to men. The finding that women went from having a survival disadvantage (unadjusted analysis) to a survival advantage (adjusted analysis) attests to the importance of including a comprehensive set of control variables, when examining sex differences.

Abstract 248: Current Status Of In-hospital Cardiac Arrest And Issues Of Collecting Data Using The Latest In-hospital Utstein-style Reporting Templates

[Background]: The outcome of in-hospital cardiac arrest has improved over the past decade, although the survival rate is still approximately 25%. The in-hospital Utstein-style reporting templates were international standard template for in-hospital cardiac arrest, with items to be substantially revised in 2019, with recommendations for standardization of records to allow objective comparisons. The aim of this study is to analyze the current status of in-hospital cardiac arrest in our hospital, and to clarify the issues in collecting the data using the in-hospital Utstein-style reporting templates. [Methods]: We collected the reports of 3 years in-hospital cardiac arrests occurred between April 2019 and March 2022 in our hospital. We described all reported items and their proportion (Patient, Pre-event, Cardiac arrest process, Post-resuscitation process, and Outcome), and calculated the missing rate of each item. [Results]: A total of 106 cases during the study period, and all reports were submitted by nurses. The median age was 74 years old (IQR: 64-81), 60.4% were male, 76.4% of cases were witnessed, chest compressions were 67.9%, and shock delivered were in 5.9%. The initial shockable rhythm was in 15.1% of cases (Table). Some items had missing data or invalid responses. Date and time of event, initial rhythm, the time of first shock delivered, and 30 days outcome had missing data (rate of missing 33%, 13.2%, 44.4%, and 80.7%, respectively), which were core items of the latest in-hospital Utstein-style reporting templates. Patient category, post-resuscitation process, reason for CPR stopped, and neurological outcome at 30 days were not measured. [Conclusions]: The high rate of missing data is considered that the nurses may not understand the meaning of the items, and suggested the need for education of nurses who submit reports.

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

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.

In-hospital Cardiac Arrest in Patients With Sepsis: A National Cohort Study.

Background: Little is known about the risk of in-hospital cardiac arrest (IHCA) among patients with sepsis. We aimed to characterize the incidence and outcome of IHCA among patients with sepsis in a national database. We then determined the major risk factors associated with IHCA among sepsis patients.Methods: We used data from a population-based cohort study based on the National Health Insurance Research Database of Taiwan (NHRID) between 2000 and 2013. We used Martin's implementation that combined the explicit ICD-9 CM codes for sepsis and six major organ dysfunction categories. IHCA among sepsis patients was identified by the presence of cardiopulmonary resuscitation procedures. The survival impact was analyzed with the Cox proportional-hazards model using inverse probability of treatment weighting (IPTW). The risk factors were identified by logistic regression models with 10-fold cross-validation, adjusting for competing risks.Results: We identified a total of 20,022 patients with sepsis, among whom 2,168 developed in-hospital cardiac arrest. Sepsis patients with a higher burden of comorbidities and organ dysfunction were more likely to develop in-hospital cardiac arrest. Acute respiratory failure, hematological dysfunction, renal dysfunction, and hepatic dysfunction were associated with increased risk of IHCA. Regarding the source of infection, patients with respiratory tract infections were at the highest risk, whereas patients with urinary tract infections and primary bacteremia were less likely to develop IHCA. The risk of IHCA correlated well with age and revised cardiac risk index (RCRI). The final competing risk model concluded that acute respiratory failure, male gender, and diabetes are the three strongest predictors for IHCA. The effect of IHCA on survival can last 1 year after hospital discharge, with an IPTW-weighted hazard ratio of 5.19 (95% CI: 5.06, 5.35) compared to patients who did not develop IHCA.Conclusion: IHCA in sepsis patients had a negative effect on both short- and long-term survival. The risk of IHCA among hospitalized sepsis patients was strongly correlated with age and cardiac risk index. The three identified risk factors can help clinicians to identify patients at higher risk for IHCA.

Novel aspects on causes of in-hospital cardiac arrest

Cardiac arrest is one of the most dramatic medical emergencies. The occurence of cardiac arrest in hospitalized patients, the so called in-hospital cardiac arrest, is common and associated with high mortality. However, in-hospital cardiac arrest has received quite little attention compared to cardiac arrest occuring outside the hospital. The present article reviews the recent literature of in-hospital cardiac arrest and outlines differences in characteristics and outcome compared to out of hospital cardiac arrest. Moreover, current literature regarding occurence and outcome of in-hospital cardiac arrest in hospitalized patients with COVID-19 is concisely summarized.

Effects of COVID-19 on in-hospital cardiac arrest: incidence, causes, and outcome \u2013 a retrospective cohort study

BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period.MethodsThis was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed.ResultsDuring the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (− 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1–9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p < 0.01); shockable rhythm (VT/VF) (18% vs 29%, p = 0.05) and defibrillation were more frequent in the pandemic period (20% vs 35%, p < 0.05). Resuscitation times, rates of ROSC and post-CA characteristics were comparable in both periods. The severity of illness (SAPS II/SOFA), frequency of mechanical ventilation and frequency of vasopressor therapy after IHCA were higher during the 2020 period. Overall, 43 patients (12 with & 31 without COVID-19), presented with respiratory failure at the time of IHCA. The Horowitz index and resuscitation time were significantly lower in patients with COVID-19 (each p < 0.01). Favourable outcomes were observed in 42 and 10% of patients with and without COVID-19-related respiratory failure, respectively.ConclusionHospital admissions declined during the pandemic, but a higher incidence of IHCA was observed. IHCA in patients with COVID-19 was a common finding. Compared to patients with non-COVID-19-related respiratory failure, the outcome was improved.

Early termination of resuscitation in in‐hospital cardiac arrest and impact to the outcome calculations

Some in-hospital resuscitation attempts are assessed futile and terminated early on. We hypothesized that if these cases are reported separately, the true outcome of in-hospital cardiac arrest is better reflected. We conducted a 3-year prospective observational Utstein-style study in Tampere, Finland. All adult in-hospital cardiac arrests outside critical care areas attended by hospital's rapid response team were included. Resuscitation attempts that were terminated within 10 minutes were considered early terminations. The cohort consisted of 199 in-hospital cardiac arrest patients. Twenty-seven (14%) resuscitation attempts were terminated early due to the presumed futility of the attempt with median resuscitation duration of 5 (4, 7) minutes. These cases and the 172 patients with full resuscitation attempt were of comparable age, sex and comorbidity. Early terminated resuscitation attempts were more often unwitnessed (63% vs. 10%, P < .001) with initial non-shockable rhythm (100% vs. 80%, P = .006) when compared with full attempts. The most frequently reported reasons for termination decisions were non-witnessed arrest presenting asystole as initial rhythm and severe acute illness. The hospital survival with good neurological outcome and 1-year survival were 30% and 25% for the whole cohort, and 34% and 29% when early terminated resuscitation attempts were excluded. One-seventh of resuscitation attempts were terminated early on due to presumed futility of the attempt. Short- and long-term outcomes were 5% and 4% better when early terminated attempts were excluded from the outcome analyses. We believe that in-hospital cardiac arrest outcome is not as poor as repeatedly presented in the literature.

Outcome of In-Hospital Cardiac Arrest in Rozh-Halat Emergency Hospital

Cardiac arrest is one of the most common complications after the hospitalization of critically ill patients. Despite this fact, there is no previous research done to study the outcome of resuscitation in our hospitals. A prospective observational study consisted of 100 consecutive patients (47 male, 53 female), their mean age of (63.65±16.7) years who suffered from cardiac arrest, and had been admitted to the Rozh-Halat Emergency Hospital with signs of life at presentation from January 2016 to April 2016. Among 100 cases, 12 of them had Return of Spontaneous Circulation (ROSC). In those cases with shockable rhythm 26% achieved ROSC, while non-shockable rhythms had only 7.8% ROSC. Among health care professionals who did Resuscitation and Cardiopulmonary Resuscitation (CPR), Emergency physicians obtained highest rates of ROSC in 7 out of 15 resuscitated cases. Most patients with cardiac arrest have non-shockable rhythm (Asystole/PEA) as their initial cardiac arrest rhythm. Better rates of ROSC were obtained when the initial rhythm was Shockable (VF/Pulseless VT) or when an emergency physician supervised/undertook the resuscitation process.

Abstract 153: Does the Revision of Resuscitation Guidelines Improve the Outcome of In-Hospital Cardiac Arrest?

Background: Resuscitation guidelines have been improved every five years using ILCOR international consensus and outcomes for out-of-hospital cardiac arrest improved. However, it remained unknown whether the outcome of in-hospital cardiac arrest has improved. The purpose of this research is to compare the outcomes of multicenter registrations in Japan and to consider the role of rapid response system (RRS). Methods: We compared the two multicenter prospective registrations for adult in-hospital cardiac arrest conducted in Japan. We compared the outcome of Japanese Registry of CPR (J-RCPR,12 hospitals) conducted in the "Guideline 2005" era and Japanese Registry for Survey Of in-hospital Resuscitation Trial (J-RESORT,8 hospitals) conducted in the "Guidelines 2010" era. We searched the number of hospitals participating in the rapid response system multicenter collaborative research (RRS) conducted in Japan. Results: J-RCPR had 491 cases, mean age 71 ± 15 years old, male 63%(311/491), J-RESORT 284 cases, mean age 72 ± 17 years old, male 68%(193/284). ROSC rate was 64.7% (318/491), 77.5% (220/284), respectively (p&lt;0.05). The survival rate after 24 hours was 49.8% (245/491), 50.7% (144/284) (NS), the survival rate after 30 days was 27.8% (137/491), 33.1% (94/284) (NS), and the favorable neurological outcome rate (CPC 1 or CPC 2) was 21.4% (105/491), 22.9% (65/284) (NS), respectively. The proportion of witnessed cardiac arrest was 77.2% (379/491), 81.7% (232/284) (NS), the location of incidence in general wards was 54.0% (265/491), 46.1% (131/284) (NS), and the shockable rhythm was 28.1% (138/491), 22.5% (64/284) (NS), respectively. In both registries, the median interval from the occurrence of cardiac arrest to the initiation of resuscitation was 0 min. The proportion of participating hospitals to RRS was only 6 facilities in 2013 and increased to 41 facilities in 2016, but still less than 1% of the total number of hospitals in Japan. Conclusion: This study showed no improvement in the outcome of in-hospital cardiac arrest and very few hospitals using RRS during the past 10 years. To improve the outcome of the in-hospital cardiac arrest, it is necessary to investigate the nation-wide status of in-hospital cardiac arrest and the effectiveness of RRS.

The association between long-term glycaemic control, glycaemic gap and neurological outcome of in-hospital cardiac arrest in diabetics: A retrospective cohort study

AimResuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. MethodsThis study was a retrospective study in a single medical centre. Patients with an IHCA between 2006 and 2015 were screened. The estimated average glucose (eAG) level was converted from the HbA1c level measured within three months prior to the IHCA. The minimum glycaemic gap was calculated from the post-resuscitation minimum BG level minus the eAG level. ResultsA total of 141 patients were included in this study. The mean HbA1c was 7.2% (corresponding eAG: 160.2 mg/dL [8.9 mmol/L]). Multivariable logistic regression analysis indicated an eAG level of less than 196 mg/dL (10.9 mmol/L; corresponding HbA1c: 8.5%) was positively associated with a favourable neurological outcome at hospital discharge (odds ratio [OR]: 5.12, 95% confidence interval [CI]: 1.11–23.70; p-value = 0.04). An absolute minimum glycaemic gap of less than 70 mg/dL (3.9 mmol/L) was also positively associated with a favourable neurological outcome (OR: 5.41, 95% CI: 1.41–20.78; p-value = 0.01). ConclusionFor diabetic patients, poor long-term glycaemic control correlated with worse neurological recovery following an IHCA. The HbA1c-derived average BG level could be used as a reference point for glycaemic management during the early stage of post-cardiac arrest syndrome. The glycaemic gap could be used to identify the optimal glycaemic range around the reference point.

Abstract P-551: OUTCOME OF IN HOSPITAL PEDIATRIC CARDIAC ARREST (IH-PCA): RESULTS FROM A TERTIARY CARE CENTRE IN PAKISTAN

Aims & Objectives: To assess the short term outcome of CPR in children in terms of Return of spontaneous circulation ROSC (initial survival) and discharge alive from hospital (final survival) at a Tertiary Care Hospital from Pakistan and to compare survival rates with beforeand after implementation of RRT and PALS training program. Methods A Prospective observational study was conducted at the Aga Khan University Hospital, Karachi from Jan 2015 to June 2017. Children between 1 month to 16 years of age, who developed in hospital cardiac arrest (IHCA) and underwent CPR, were included in the study. Data collection was reported according to Utstein style. The outcome were sustained return of spontaneous circulation (initial survival) and hospital discharge (final survival). Results A total of 89 Cardiopulmonary resuscitation were performed. Incidence of CPR was 0.85% for all admissions; (8.5 CPR/1000 admissions). Most patients who had CPR had underlying circulatory shock. Pulseless electrical activity was noted in 47% of our patients. Return of spontaneous circulation (ROSC) was achieved in 51.7% (n =46) and 28% (n=23) patients were alive at time of discharge. Our data suggested that CPR of <20 min duration was associated with better outcome in sustained survival at discharge. (p <0.001). On comparison with previous study conducted in same centre before implementation of PALS and RRT, we observed better outcome in form of survival at discharge from 13% to 28% (p <0.001). Conclusions We observed that that CPR (< 20 minutes) is predictor for better outcome. Significant improvement in outcome of IHCA noted after implementation of PALS.

Comparison of the Between the Flags calling criteria to the MEWS, NEWS and the electronic Cardiac Arrest Risk Triage (eCART) score for the identification of deteriorating ward patients

IntroductionTraditionally, paper based observation charts have been used to identify deteriorating patients, with emerging recent electronic medical records allowing electronic algorithms to risk stratify and help direct the response to deterioration. Objective(s)We sought to compare the Between the Flags (BTF) calling criteria to the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS) and electronic Cardiac Arrest Risk Triage (eCART) score. Design and participantsMulticenter retrospective analysis of electronic health record data from all patients admitted to five US hospitals from November 2008-August 2013.Main outcome measures: Cardiac arrest, ICU transfer or death within 24h of a score ResultsOverall accuracy was highest for eCART, with an AUC of 0.801 (95% CI 0.799–0.802), followed by NEWS, MEWS and BTF respectively (0.718 [0.716–0.720]; 0.698 [0.696–0.700]; 0.663 [0.661–0.664]). BTF criteria had a high risk (Red Zone) specificity of 95.0% and a moderate risk (Yellow Zone) specificity of 27.5%, which corresponded to MEWS thresholds of >=4 and >=2, NEWS thresholds of >=5 and >=2, and eCART thresholds of >=12 and >=4, respectively. At those thresholds, eCART caught 22 more adverse events per 10,000 patients than BTF using the moderate risk criteria and 13 more using high risk criteria, while MEWS and NEWS identified the same or fewer. Conclusion(s)An electronically generated eCART score was more accurate than commonly used paper based observation tools for predicting the composite outcome of in-hospital cardiac arrest, ICU transfer and death within 24h of observation. The outcomes of this analysis lend weight for a move towards an algorithm based electronic risk identification tool for deteriorating patients to ensure earlier detection and prevent adverse events in the hospital.

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

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.

Profile and Outcome of In-hospital Cardiac Arrest in Coronary Care Unit of a Tertiary Care Hospital

Background: In-hospital cardiac arrests are associated with poor survival despite basic and advanced life support measures. Objective of this study was to find out the profile and outcome of in-hospital cardiac arrest patients admitted to coronary care unit (CCU) of Chittagong Medical College Hospital.Methods: This prospective observational study was done on 243 consecutive patients developing cardiac arrest in CCU of Chittagong Medical College Hospital during a period of 1 year. Baseline demographics, clinical data, such as mode of arrest, timing of the event, duration of resuscitation were recorded. Basic and advanced life support measures were given according to AHA guidelines. The main outcomes were death and survival to hospital discharge with or without severe neurological disability.Results: There were 168 male and 75 female. Male:female ratio was 2.4:1.Mean age of the study population was 56.5±14.6 (range 23-76 yrs). Out of 243 arrest cases 108 (44.4%) had ventricular fibrillation(VF), 75(30.8%) had pulseless ventricular tachycardia(VT), 51 (20.8%) had pulseless electrical activity(PEA) and 9 patients (3.7%) had asystole. Mean±SD of time to defibrillation was 1.8±4.3min (range 0-30 min). Ninety eight (40.2%) patients had a return to spontaneous circulation, 71 (29.2%) survived up to 24 hours and only 46 (18.9%) patients survived to hospital discharge. Out of the 183 patients with VF and pulseless VT, 42 (22.9%) survived to hospital discharge. Survival following asystole and PEA were only 6.6% in each.Conclusion: Only 18.9% of cardiac arrest victims survived to hospital discharge. Initial cardiac arrest rhythm as VF and pulseless VT, a shorter time to defibrillation and location whether the event in monitored area were factors associated with a higher survival.Cardiovasc. j. 2016; 8(2): 123-127

Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China

ObjectiveTo assess the incidence and outcome of in-hospital cardiac arrests (IHCAs) in Beijing, China. MethodsThe incidence and outcome of IHCAs over a 12-month period were evaluated in this prospective study. Between January 1 and December 31, 2014, 12 Beijing hospitals prospectively participated in this study for calculation of the incidence of IHCA. Data were collected according to the Utstein style for all cases of attempted resuscitation for IHCA that occurred in the participating hospitals. Surviving patients were followed for 1 month. ResultsThe total number of admissions across the 12 hospitals during this 1-year period was 582,242; the IHCA incidence was 17.5 per 1000 admissions. Of the 10,198 IHCAs recorded, cardiopulmonary resuscitation (CPR) was initiated in 26.6%. Among CPR recipients, 1292 (47.6%) had a presumed cardiac aetiology and 1255 occurred in the Emergency Department. With regards to initial rhythm, 1340 had asystole and 423 had shockable rhythms. Of those receiving CPR, 1451 (53.5%) patients received it in less than 1min. Restoration of spontaneous circulation was achieved in 962 (35.5%) patients; 247 (9.1%) patients were discharged alive and 174 (6.4%) patients had good neurological outcomes. At 1 month after discharge, 236 patients remained alive. On multivariate regression analysis, factors associated with survival included female sex, age <60 years, and ventricular fibrillation/ventricular tachycardia as the initial rhythm. ConclusionThe incidence of IHCA in Beijing hospitals is high and the survival is poor compared to other industrialized countries.

Periarrest Modified Early Warning Score (MEWS) predicts the outcome of in-hospital cardiac arrest.

The Modified Early Warning Score (MEWS) reflects the physiological changes of cardiac arrest and has been used in identifying patient deterioration. Physiological reserve capacity is an important outcome predictor, but is seldom reported due to recording limitations in cardiac arrest patients. The aim of the study was to evaluate whether periarrest MEWS could be a further prognostic factor in in-hospital cardiac arrest. This was a retrospective cohort study of nontrauma adult patients who had experienced in-hospital cardiac arrest during emergency department stays at an urban, 2600-bed tertiary medical center in Taiwan from February 2011 to July 2013. Data regarding patients' characteristics, Charlson Comorbidity Score, MEWS score before events, mode of arrest, and outcome details were extracted following the Utstein guidelines for uniform reporting of cardiac arrest. During the 30-month period, 234 patients suffered in-hospital cardiac arrest during emergency department stays, and 99 patients with periarrest MEWS were included in the final analysis. The MEWS at triage did not differ significantly between survival-to-discharge and mortality groups (3.42±2.2 vs. 4.02±2.65, p=0.811). Periarrest MEWS was lower in the survival-to-discharge group (4.41±2.28 vs. 5.82±2.84, p=0.053). In multivariate logistic regression analysis, periarrest MEWS was an independent predictors for survival to discharge. A rise in periarrest MEWS reduced the chance of survival to discharge by 0.77-fold (95% confidence interval: 0.60-0.97, p=0.028). The simplest MEWS system not only can be used as a prevention measure, but the periarrest MEWS could also be considered as an independent predictor of mortality after in-hospital cardiac arrest.

Relationship between previous severity of illness and outcome of in-hospital cardiac arrest

Objectives: To analyse the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. Methods: The study included a total of 44 children aged from 1 month to 18 years who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analysed. Results: The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), p = .04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors.

Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit

ObjectiveTo report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. MethodsA prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge. ResultsThe overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2–2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. ConclusionsThese first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest.

Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.