Causes of in-hospital cardiac arrest and influence on outcome

Wallmüller, Christian; Meron, Giora; Kürkciyan, Istepan; Schober, Andreas; Stratil, Peter; Sterz, Fritz

doi:10.1016/j.resuscitation.2012.05.001

Cited by 123 publications

(110 citation statements)

References 28 publications

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“…Although this proportion is lower than that reported by Merchant et al 8 30 (39% with VF), our findings correlate well with several other studies using the Get With The Guidelines-Resuscitation registry that showed VT/VF as the cardiac arrest rhythm in 19.2% to 25.8% of IHCA patients. [7][8][9][10]24,30,37 Overall survival to discharge in our study was higher than in previous reports, particularly in patients with PEA/asystole. 9,10,38 Patient who did not have ICD-9-CM codes for VT or VF were presumed to have PEA/asystole in our study.…”

Section: Discussionsupporting

confidence: 89%

“…The prevalence of most comorbidities was similar across all regions among patients who experienced an IHCA, suggesting that the burden of comorbidities or illness may contribute little to the regional differences in IHCA rates. In a single-center study, Wallmuller et al 30 showed that IHCA is attributable to cardiac causes in 63% of cases with either VF or PEA/asystole as the cardiac arrest rhythm. Regional differences in receipt of guideline-recommended therapies for patients admitted with cardiovascular diseases have been well described and may contribute to some of the regional differences in IHCA, particularly those events related to a cardiac origin.…”

Section: Discussionmentioning

confidence: 99%

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Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

et al. 2015

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Background— Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications. Methods and Results— We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients ≥18 years of age who underwent cardiopulmonary resuscitation ( International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838 465 patients with IHCA, 162 270 (19.4%) were in the Northeast, 159 581 (19.0%) were in the Midwest, 316 201 (37.7%) were in the South, and 200 413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31–1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19–1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23–1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all P trend <0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast. Conclusions— We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

et al. 2015

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“…Our patients were reported to have suffered from cardiac arrest in the majority of the cases, a higher proportion than that reported in the literature [25], yet only 30% suffered from acute myocardial infarction indicating that the labeling of cardiac arrest is probably overestimated or that it was a mixed respiratory cardiac arrest.…”

Section: Discussioncontrasting

confidence: 63%

Older Adults Had Similar Survival Rates Compared to Their Younger Counterparts Following Cardiopulmonary Resuscitation

Ahmar¹,

Eid²,

Imad³

et al. 2017

AAR

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Background: Several factors affect the outcome of cardiopulmonary resuscitation (CPR) following in hospital cardiac arrests, including presence of comorbidities, arrest characteristics, and resuscitation efforts. We sought to determine the outcome of CPR provided to elders suffering from in-hospital cardiopulmonary arrest and to compare it to the survival of their younger counterparts in a tertiary care center in Lebanon. Methods: Retrospective chart review of all patients suffering from cardiac arrests who received CPR during a one year period in a tertiary care center located in a rural area. Results: A total of 98 cardiac arrests were identified who received CPR according to advance cardiac life support protocols (ACLS). Initial return of spontaneous circulation was higher among younger subjects but the difference was not statistically significant (52.6% vs 34.2%, p = 0.136). Survival to discharge was low but slightly higher in the younger subgroup, yet the difference was not statistically significant (5% vs 3%, p = 0.535). Conclusions: Physicians need to be aware of the outcome of CPR in the hospitals they practice in. They can educate their patients about CPR outcome. Such education may help patients and their next of kin make informed decisions jointly with their physician regarding resuscitation.

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“…Thus, we cannot be certain that outcomes in Medicare beneficiaries have not also improved since 2005. Finally, we do not know the initial arrest rhythm, which is an important variable associated with survival [34], as survival rates are highest among patients with ventricular tachycardia or fibrillation [11][12][13]16,30,31,34,[36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation Among Mechanically Ventilated Patients

Alalwan¹,

Ehlenbach²,

Young³

et al. 2012

C105. Ethics and End of Life Care in the Intensive Care Unit

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Purpose-To evaluate the outcomes, including long term survival, after CPR in mechanically ventilated patients.Methods-We analyzed Medicare data from 1994-2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated (defined by ICD-9 procedure code for intubation [96.04] Results-We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4% (95% confidence interval [CI] 18.3-18.5%). Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1% (95% CI 9.8%-10.4%), compared to 19.2% (95% CI 19.1%-19.3%) in non-ventilated patients (p<0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52% lower odds of survival (OR 0.48, 95% CI 0.46-0.49, p<0.001). Median long term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95% CI 5.3-6.8 months), compared to 19.0 months (95% CI 18.6-19.5 months) among the non-ventilated survivors (p=<0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1% were alive at one year. Conclusions-Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.

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Causes of in-hospital cardiac arrest and influence on outcome

Cited by 123 publications

References 28 publications

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States

Older Adults Had Similar Survival Rates Compared to Their Younger Counterparts Following Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation Among Mechanically Ventilated Patients

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