Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team

Harrison, David A; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B.; Gwinnutt, Carl; Nolan, Jerry P.; Rowan, Kathy

doi:10.1016/j.resuscitation.2014.05.004

Cited by 39 publications

(56 citation statements)

References 21 publications

(14 reference statements)

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“…Arrests with a non-shockable rhythm were also strongly associated with worse event survival than those with a shockable rhythm; consistent with previous research. 10,[14][15][16][17][18] In particular, asystole was associated with greater survival to, and beyond discharge than PEA, whereas previous research suggests asystole is associated with the worst survival of all rhythms. 15,17 Further work may be required to investigate the aetiologies of these rhythms for IHCA.…”

Section: Short-term Survivalmentioning

confidence: 76%

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

et al. 2019

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Introduction: Evidence about the immediate survival from in-hospital cardiac arrest (IHCA) is well established, however, beyond discharge there is very little describing the long-term outcomes of these patients. Of the few existing studies, all have been conducted in metropolitan centres. Therefore, this study describes survival from IHCA in both the short and long-term in a large regional hospital cohort. Method: A retrospective cohort study was conducted including all adult patients who suffered an IHCA between 1 February 2000 and 31 December 2017 in a large regional (non-metropolitan) hospital in Victoria, Australia. Characteristics of the arrest and patient were sourced from a prospectively collected database that captures all of the arrests occurring in the hospital. Mortality data after discharge were sourced from the state death registry, censored on 31 January 2018. Results: A total of 629 patients were included in the study. Of these, 357 (57%) survived the event, and 213 (34%) survived to discharge. At one-year post-arrest 27% of the original cohort were still alive. The age of the patient, arrest rhythm, location and duration of resuscitation were all significantly associated with long-term survival. Conclusion: Both short and long-term survival following an IHCA in a regional hospital are similar to previously described rates in metropolitan hospitals. Further research is required on the post-discharge correlates of long-term survival.

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Section: Short-term Survivalmentioning

confidence: 76%

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

et al. 2019

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“…These associations were then reassessed after adjustment for the risk factors included in the NCAA risk prediction models, 21 that is, age, sex (in the ROSC>20 min model only), prior hospital length of stay, reason for admission to/attendance at hospital, location of IHCA and presenting/first documented rhythm. Information about the categorisation of the included variables is provided in an earlier NCAA publication 21 and in online supplementary files 1 and 2. The development set for the NCAA models contained 14 688 patients with an IHCA, of which 6605 (45.0%) achieved ROSC>20 min and 2926 (19.9%) survived to hospital discharge.…”

Section: Logistic Regression Analysismentioning

confidence: 99%

“…The development set for the NCAA models contained 14 688 patients with an IHCA, of which 6605 (45.0%) achieved ROSC>20 min and 2926 (19.9%) survived to hospital discharge. 21 Predicted probabilities for ROSC>20 min and survival to hospital discharge were calculated for each arrest. A hospital-level random effect was included in the models to adjust for clustering of outcomes at the hospital level.…”

Section: Logistic Regression Analysismentioning

confidence: 99%

“…20 As it is not known if risk-adjusted outcomes for IHCA occurring at weekends and at night in UK acute hospitals are worse than for those occurring during weekday daytime, we investigated this using the NCAA database and the NCAA risk models for IHCA outcomes. 21 We also attempted to discover if any observed difference was attributable to the case mix of patients resident in hospital or to care delivery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

Robinson¹,

Smith

Power

et al. 2015

BMJ Qual Saf

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BackgroundInternationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events.ObjectiveTo describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care.MethodsWe performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals.ResultsRisk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses.ConclusionsIHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.

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“…Like the GWTG-R investigators, the NCAA investigators have developed a risk model to enable comparisons between participating hospitals. 20 Risk models such as this have also enabled studies that show lower survival rates following CA during nights and weekends compared with those occurring during the day. 21,22 A recent study has documented the incidence and outcome from IHCA over a 12-month period in 12 hospitals in Beijing, China.…”

Section: In-hospital Cardiac Arrestmentioning

confidence: 99%

Cardiac Arrest and Cardiopulmonary Resuscitation

Nolan

2017

Semin Neurol

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In this review, the author summarizes the incidence, causes, and survival associated with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). The resuscitation guideline process is outlined, and the impact of resuscitation interventions is discussed. The incidence of OHCA treated by emergency medical services varies throughout the world, but is in the range of 30 to 50 per 100,000 of the population. Survival-to-hospital-discharge rates also vary, but are in the range of 8 to 10% for many countries. Cardiac disease accounts for the vast majority of OHCAs; however, although it is a common cause of IHCAs, many other diseases are also common causes of IHCA. Five yearly reviews of resuscitation science have been facilitated in recent years by the International Liaison Committee on Resuscitation; these have been followed by the publication of regional resuscitation guidelines. There is good evidence that increasing rates of bystander cardiopulmonary resuscitation and earlier defibrillation are both contributing to improving the survival rate after an OHCA.

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Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team

Cited by 39 publications

References 21 publications

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

Cardiac Arrest and Cardiopulmonary Resuscitation

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