Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

Keane, Ryan; Brown, Kelly M.; Loriaux, Daniel; Kendsersky, Payton; Alviar, Carlos L.; Arps, Kelly; Berg, David D.; Bohula, Erin A.; Burke, James A.; Dixson, Jeffrey; Gerber, Daniel; Goldfarb, Michael; Granger, Christopher B.; Guo, Jianping; Harrison, Robert W.; Kontos, Michael C.; Lawler, Patrick R.; Miller, P. Elliott; Nativi-Nicolau, José; Newby, L. Kristin; Racharla, Lekha; Roswell, Robert O.; Shah, Kevin; Sinha, Shashank S.; Solomon, Michael A.; Teuteberg, Jeffrey J.; Wong, Graham C.; Diepen, Sean van; Katz, Jason N.; Morrow, David A.

doi:10.1016/j.resuscitation.2022.12.002

Cited by 8 publications

(3 citation statements)

References 29 publications

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“…South Swedish ICU data (799 patients, 245 IHCAs, 554 OHCAs, 2014-2018) showed ICU admissions after IHCA were older (median 73 vs. 68 years), less commonly men (62 vs. 73%), were more (90 vs. 73%), had fewer shockable rhythms (21 vs. 48%) but had better outcomes (40 vs. 32% for good neurological survival) than after OHCA ICU admissions [12]. The Canadian and US Critical Care Cardiology Trials Network of tertiary cardiology ICUs has reported similar data (2075 admissions, 29 centres, 1044 IHCAs, 1031 OHCAs, 2017-2021) [13]. Their ICU admissions after IHCA were older (median 66 vs. 62 years), less commonly men (64 vs. 69%), were more likely to have comorbidities but had fewer in hospital deaths (36.1 vs. 44.1%) than after OHCA ICU admissions.…”

Section: Epidemiology and Outcomesmentioning

confidence: 88%

In-hospital cardiac arrest

Soar

2023

Current Opinion in Critical Care

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Purpose of reviewTo describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.Recent findingsImproving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are disparities in care based on patient sex, ethnicity and socioeconomic status that need to be tackled. The increased use of emergency treatment plans that include do-not attempt cardiopulmonary resuscitation recommendations will help to decrease the number of resuscitation attempts. System approaches and strong local leadership through resuscitation champions can improve patient outcomes.SummaryIn-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.

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Section: Epidemiology and Outcomesmentioning

confidence: 88%

In-hospital cardiac arrest

Soar

2023

Current Opinion in Critical Care

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“…In a multicenter study including 2075 admissions with IHCA and OHCA, the IHCA patients had significantly higher comorbidities, lower lactate, greater utilization of invasive hemodynamics and mechanical circulatory support, lesser TTM and lesser in-hospital mortality (36.1% vs 44.1%) than IHCA patients[ 95 ]. Another study on 779 post-cardiac arrest patients[ 96 ] revealed that IHCA patients were older, less frequently male, and less frequently without comorbidity.…”

Section: Outcomes Of Ihca and Ohcamentioning

confidence: 99%

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

El-Menyar,

Wahlen

2024

World J Cardiol

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The post-resuscitation period is recognized as the main predictor of cardiopulmonary resuscitation (CPR) outcomes. The first description of post-resuscitation syndrome and stony heart was published over 50 years ago. Major manifestations may include but are not limited to, persistent precipitating pathology, systemic ischemia/reperfusion response, post-cardiac arrest brain injury, and finally, post-cardiac arrest myocardial dysfunction (PAMD) after successful resuscitation. Why do some patients initially survive successful resuscitation, and others do not? Also, why does the myocardium response vary after resuscitation? These questions have kept scientists busy for several decades since the first successful resuscitation was described. By modifying the conventional modalities of resuscitation together with new promising agents, rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal, stony heart. Community awareness and staff education are crucial for shortening the resuscitation time and improving short- and long-term outcomes. Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes. This review extensively addresses the underlying pathophysiology, management, and outcomes of post-resuscitation syndrome. The pattern, management, and outcome of PAMD and post-cardiac arrest shock are different based on many factors, including in-hospital cardiac arrest vs out-of-hospital cardiac arrest (OHCA), witnessed vs unwitnessed cardiac arrest, the underlying cause of arrest, the duration, and protocol used for CPR. Although restoring spontaneous circulation is a vital sign, it should not be the end of the game or lone primary outcome; it calls for better understanding and aggressive multi-disciplinary interventions and care. The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

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“…High mortality rates occurring due to WLST, however, are constantly emphasizing the need for reassessing the indications for WLST, to avoid inappropriate withdrawal of medical care which may result in unnecessary loss of life, given the fact that in-hospital mortality of these patients is very high even when not taking into consideration these treatment limitation decisions [ 318 , 319 ]. American Heart Association recommendations published in 2015 suggesting that neuro-prognostication should be carried out at least 72 hours after the completion of post-TTM rewarming and at least 72 hours after ROSC in patients not receiving TTM [ 165 ] are recently adjusted recommending that observation should be prolonged to seven days after the end of TTM or sedation suspension [ 171 , 320 ].…”

Section: Reviewmentioning

confidence: 99%

Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors

Nikolovski,

Lazic,

Fiser

et al. 2024

Cureus

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As an important public health issue, out-of-hospital cardiac arrest (OHCA) requires several stages of high quality medical care, both on-field and after hospital admission. Post-cardiac arrest shock can lead to severe neurological injury, resulting in poor recovery outcome and increased risk of death. These characteristics make this condition one of the most important issues to deal with in post-OHCA patients hospitalized in intensive care units (ICUs). Also, the majority of initial post-resuscitation survivors have underlying coronary diseases making revascularization procedure another crucial step in early management of these patients. Besides keeping myocardial blood flow at a satisfactory level, other tissues must not be neglected as well, and maintaining mean arterial pressure within optimal range is also preferable. All these procedures can be simplified to a certain level along with using targeted temperature management methods in order to decrease metabolic demands in ICU-hospitalized post-OHCA patients. Additionally, withdrawal of life-sustaining therapy as a controversial ethical topic is under constant re-evaluation due to its possible influence on overall mortality rates in patients initially surviving OHCA. Focusing on all of these important points in process of managing ICU patients is an imperative towards better survival and complete recovery rates.

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Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

Cited by 8 publications

References 29 publications

In-hospital cardiac arrest

In-hospital cardiac arrest

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors

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