Circadian variation of in-hospital cardiac arrest

Tripathi, Avnish; Girotra, Saket; Toft, Lorrel E.B.

doi:10.1016/j.resuscitation.2020.08.014

Cited by 5 publications

(16 citation statements)

References 30 publications

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“…Circadian variation of the autonomic nervous system and heart rate variability has been demonstrated in experimental animal models, and CPA due to SHKR is variably reported to be affected by circadian cycles in people. [68][69][70][71] In this patient population, OHCA was associated with decreased odds of having both I-SHKRs and S-SHKRs. A possible explanation is that OHCA cases are less likely to be witnessed arrests, and in people, witnessed arrests are consistently associated with increasing odds of I-SHKRs and S-SHKRs.…”

Section: Discussionmentioning

confidence: 70%

“…Initial shockable cardiac arrest rhythms were less likely to be diagnosed during daytime hours, the reasons for which are not easily explained but may be partially triggered by the circadian cycle of the autonomic nervous system and alterations to it. Circadian variation of the autonomic nervous system and heart rate variability has been demonstrated in experimental animal models, and CPA due to SHKR is variably reported to be affected by circadian cycles in people 68–71 …”

Section: Discussionmentioning

confidence: 99%

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Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study

Vega Suarez,

Epstein,

Martin

et al. 2023

J Vet Emergen Crit Care

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ObjectiveTo report the prevalence of initial shockable cardiac arrest rhythms (I‐SHKR), incidence of subsequent shockable cardiac arrest rhythms (S‐SHKR), and factors associated with I‐SHKRs and S‐SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR.DesignMulti‐institutional prospective case series from 2016 to 2021, retrospectively analyzed.SettingEight university and eight private practice veterinary hospitals.AnimalsA total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry.Measurements and Main ResultsLogistic regression was used to evaluate association of animal, hospital, and arrest variables with I‐SHKRs and S‐SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I‐SHKRs. Odds for I‐SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S‐SHKRs. Odds for S‐SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I‐SHKRs nor S‐SHKRs were significantly associated with ROSC.ConclusionsI‐SHKRs and S‐SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study

Vega Suarez,

Epstein,

Martin

et al. 2023

J Vet Emergen Crit Care

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“…Several previous studies have examined the circadian pattern of cardiac arrest, but the findings remain inconsistent. OHCA occurrences appeared to have a morning peak ( 22 – 24 ); however, IHCA does not seem to have a circadian pattern ( 25 ). By contrast, in this study, ED-based IHCA mortality rate was highest at night.…”

Section: Discussionmentioning

confidence: 93%

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010–2018

Sung

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundLittle is known about the in-hospital cardiac arrest (IHCA) in the US emergency department (ED). This study aimed to describe the incidence and mortality of ED-based IHCA visits and to investigate the factors associated with higher incidence and poor outcomes of IHCA.Materials and MethodsData were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 2010 and 2018. Adult ED visits with IHCA were identified using the cardiopulmonary resuscitation code, excluding those with out-of-hospital cardiac arrest. We used descriptive statistics and multivariable logistic regression accounting for NHAMCS’s complex survey design. The primary outcome measures were ED-based IHCA incidence rates and ED-based IHCA mortality.ResultsOver the 9-year study period, there were approximately 1,114,000 ED visits with IHCA. The proportion of IHCA visits in the entire ED population (incidence rate, 1.2 per 1,000 ED visits) appeared stable. The mean age of patients who visited the ED with IHCA was 60 years, and 65% were men. Older age, male, arrival by ambulance, and being uninsured independently predicted a higher incidence of ED-based IHCA. Approximately 51% of IHCA died in the ED, and the trend remained stable. Arrival by ambulance, nighttime, or weekend arrival, and being in the non-Northeast were independently associated with a higher mortality rate after IHCA.ConclusionThe high burden of ED visits with IHCA persisted through 2010–2018. Additionally, ED-based IHCA survival to hospital admission remained poor. Some patients were disproportionately affected, and certain contextual factors were associated with a poorer outcome.

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“…The number of total activations used in model building ranged from just over 72,000 (electrocutions and lightning strikes) to more than 52 million (general sick person), per category, for the thirteen years covered by the NEMSIS data set. With the exception of 2 previous studies, one of comparable size which was really a meta-analysis of 30 studies (Cohen et al, 1997) and one which is roughly twice the size of our smallest (Tripathi et al, 2020), the patient event numbers used to model the daily patterns in our investigation dwarf sizes of studies cited in Tables 1 and 2. In the data, there were more than half a million activations for almost 85% of the medical event categories; three quarters had more than one million activations; and nearly 30% had more than 10 million activations; see Table 4.…”

Section: Resultsmentioning

confidence: 99%

“…Most notably, acute myocardial infarction ( heart attack ), cerebrovascular accident ( stroke ), and sudden cardiac arrest/death have long been perceived as prevalent in the morning (Cohen et al, 1997; Elliott, 1998; Muller et al, 1985, 1987; Muller, 1999; Rocco et al, 1987; Thakur et al, 1996; Willich et al, 1987). Several reviews and studies have supported or confirmed before-noon occurrence peaks (Akkaya-Kalayci et al, 2017; Buurma et al, 2019; Klerman, 2005), while others failed to replicate a morning tendency (Faramand et al, 2019; Ni et al, 2019; Tripathi et al, 2020; Vencloviene et al, 2017); see Tables 1 and 2.…”

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confidence: 99%

The Daily Patterns of Emergency Medical Events

Helander,

Formica,

Bergen-Cico

2023

J Biol Rhythms

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This study examines population-level daily patterns of time-stamped emergency medical service (EMS) dispatches to establish their situational predictability. Using visualization, sinusoidal regression, and statistical tests to compare empirical cumulative distributions, we analyzed 311,848,450 emergency medical call records from the US National Emergency Medical Services Information System (NEMSIS) for years 2010 through 2022. The analysis revealed a robust daily pattern in the hourly distribution of distress calls across 33 major categories of medical emergency dispatch types. Sinusoidal regression coefficients for all types were statistically significant, mostly at the p < 0.0001 level. The coefficient of determination [Formula: see text] ranged from 0.84 and 0.99 for all models, with most falling in the 0.94 to 0.99 range. The common sinusoidal pattern, peaking in mid-afternoon, demonstrates that all major categories of medical emergency dispatch types appear to be influenced by an underlying daily rhythm that is aligned with daylight hours and common sleep/wake cycles. A comparison of results with previous landmark studies revealed new and contrasting EMS patterns for several long-established peak occurrence hours—specifically for chest pain, heart problems, stroke, convulsions and seizures, and sudden cardiac arrest/death. Upon closer examination, we also found that heart attacks, diagnosed by paramedics in the field via 12-lead cardiac monitoring, followed the identified common daily pattern of a mid-afternoon peak, departing from prior generally accepted morning tendencies. Extended analysis revealed that the normative pattern prevailed across the NEMSIS data when reorganized to consider monthly, seasonal, daylight-savings versus civil time, and pre-/post-COVID-19 periods. The predictable daily EMS patterns provide impetus for more research that links daily variation with causal risk and protective factors. Our methods are straightforward and presented with detail to provide accessible and replicable implementation for researchers and practitioners.

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Circadian variation of in-hospital cardiac arrest

Cited by 5 publications

References 30 publications

Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study

Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010–2018

The Daily Patterns of Emergency Medical Events

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