Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases

Hessulf, Fredrik; Karlsson, Thomas; Lundgren, Peter; Aune, Solveig; Strömsöe, Annelie; Källestedt, Marie-Louise Södersved; Djärv, Therese; Herlitz, Johan; Engdahl, Johan

doi:10.1016/j.ijcard.2017.12.068

Cited by 63 publications

(76 citation statements)

References 33 publications

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“…Thus, the incidence of early fever was relatively low. However, multiple comorbidities and multiorgan failure are more common in IHCA patients (1,24). Concerning our results, the relative and absolute duration of fever, which is a relatively higher IDF and fever lasting more than 5 days, was related to a poor survival rate.…”

Section: Discussioncontrasting

confidence: 46%

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis

Guo

Wang

et al. 2020

Front. Med.

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The aim of this research was to study the factors contributing to the survival rate of in-hospital cardiac arrest (IHCA) and to determine whether the incidence density of fever (IDF) acts as a mediator. Methods: Data from patients with IHCA who survived more than 48 h were collected from 2011 to 2017. IDF was defined as the fever duration divided by the hospitalization duration, prolonged fever was defined as fever lasting for more than 5 days, and early fever was defined as an initial onset within the first 2 days of IHCA. Possible clinical variables associated with IDF were examined by linear regression, and possible clinical variables associated with survival rate were examined by univariate and multivariate analyses. IDF was investigated as a mediator of the indirect effects of the risk factors on survival. Results: In our retrospective study, the median IDF was 0, with an interquartile range from 0 to 0.42. Prolonged fever was noted in 16% (97/605) of the total, and early fever was noted in 17.2% (104/605) of the total. Linear regression results showed that positive chest X-ray, central venous catheter and Glasgow Coma Score (GCS) ≤ 8 were related to IDF. The IDF (OR: 0.36, 95% CI, 0.13-0.97, P = 0.04), prolonged fever (adjusted OR = 0.13, 95% CI, 0.06-0.29, P < 0.001), positive chest X-ray (OR: 0.67, 95% CI, 0.46-0.98, P = 0.04), central venous catheter placement (OR: 0.54, 95% CI, 0.34-0.89, P = 0.01), and endotracheal intubation (OR: 0.47, 95% CI, 0.33-0.69, P < 0.001) were also related to the negative outcome of hospital discharge after adjustment. Additionally, positive chest X-ray had a 19% effect on survival outcome through IDF as a mediator, and the indirect effect of central venous catheter mediated by IDF accounted for 10% of the total. Conclusions: A higher IDF, prolonged fever, a positive chest X-ray, the use of a central venous catheter and endotracheal intubation reduced the survival rate of these patients, and the detrimental impacts of a positive chest X-ray and the use of a central venous catheter on survival outcomes were partially mediated by IDF.

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Section: Discussioncontrasting

confidence: 46%

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis

Guo

Wang

et al. 2020

Front. Med.

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“…In the propensity score we have included variables that in previous studies have been shown to affect outcome. 1 When adjusting for these variables, pulmonary aspiration was associated with a lower 30-day survival rate. We checked the consistency of our results by 1 computing propensity scores using gradient boosting, a machine learning algorithm, as well as 2 using logistic regression, without propensity scores, and there were no material differences in the obtained ORs.…”

Section: Discussionmentioning

confidence: 98%

“…The primary aim of the registry is to improve the quality of care among patients who suffer from IHCA and furthermore to study incidence, demographics and predictors of survival among these patients. 1 During the first year (2005), 10 hospitals participated, since then the number of participating hospitals has increased to include 96% (70/73) of all Swedish hospitals in 2017. The hospitals vary in size from secondary hospitals with fewer than 50 beds to university hospitals with over 1000 beds (range 45 to 1165).…”

Section: Patientsmentioning

confidence: 99%

“…In Sweden in 2017 the incidence of IHCA was 1.7 per 1000 hospital admissions. 1 Among patients with IHCA where advanced cardiac life support (ACLS) is initiated the survival rate has been reported to range between 17% to 30%. [1][2][3][4] Initial heart rhythm has been reported to be the strongest predictor of survival, with a survival rate of about 50% if the initial rhythm is shockable, that is, ventricular fibrillation or pulseless ventricular tachycardia and about 10% if the initial rhythm is non-shockable, that is, asystole or pulseless electrical activity.…”

Section: Introductionmentioning

confidence: 99%

“…1 Among patients with IHCA where advanced cardiac life support (ACLS) is initiated the survival rate has been reported to range between 17% to 30%. [1][2][3][4] Initial heart rhythm has been reported to be the strongest predictor of survival, with a survival rate of about 50% if the initial rhythm is shockable, that is, ventricular fibrillation or pulseless ventricular tachycardia and about 10% if the initial rhythm is non-shockable, that is, asystole or pulseless electrical activity. [5][6][7][8] Previous studies have also identified a higher survival rate when the IHCA occurred in the intensive care unit (ICU), cardiology care units (CCU) or in the cardiac catheterisation laboratory as compared with on general wards (60% vs 20%).…”

Section: Introductionmentioning

confidence: 99%

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Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study

et al. 2020

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ObjectiveTo study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.DesignA retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).SettingThe SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.ParticipantsThe study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).Primary and secondary outcome measuresPrimary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.ResultsIn the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).ConclusionsIn-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.

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Prognostic implication of heart failure stage and left ventricular ejection fraction for patients with in-hospital cardiac arrest: a 16-year retrospective cohort study

Wang,

Ho,

et al. 2024

Clin Res Cardiol

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Background The 2022 AHA/ACC/HFSA guidelines for the management of heart failure (HF) makes therapeutic recommendations based on HF status. We investigated whether the prognosis of in-hospital cardiac arrest (IHCA) could be stratified by HF stage and left ventricular ejection fraction (LVEF). Methods This single-center retrospective study analyzed the data of patients who experienced IHCA between 2005 and 2020. Based on admission diagnosis, past medical records, and pre-arrest echocardiography, patients were classified into general IHCA, at-risk for HF, pre-HF, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction or HF with reduced ejection fraction (HFmrEF-or-HFrEF) groups. Results This study included 2,466 patients, including 485 (19.7%), 546 (22.1%), 863 (35.0%), 342 (13.9%), and 230 (9.3%) patients with general IHCA, at-risk for HF, pre-HF, HFpEF, and HFmrEF-or-HFrEF, respectively. A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favorable neurological recovery. Multivariable logistic regression analysis indicated that pre-HF and HFpEF were associated with better neurological (pre-HF, OR: 2.11, 95% confidence interval [CI]: 1.23–3.61, p = 0.006; HFpEF, OR: 1.90, 95% CI: 1.00–3.61, p = 0.05) and survival outcomes (pre-HF, OR: 2.00, 95% CI: 1.34–2.97, p < 0.001; HFpEF, OR: 1.91, 95% CI: 1.20–3.05, p = 0.007), compared with general IHCA. Conclusion HF stage and LVEF could stratify patients with IHCA into different prognoses. Pre-HF and HFpEF were significantly associated with favorable neurological and survival outcomes after IHCA. Further studies are warranted to investigate whether HF status-directed management could improve IHCA outcomes.

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Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases

Cited by 63 publications

References 33 publications

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis

Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study

Prognostic implication of heart failure stage and left ventricular ejection fraction for patients with in-hospital cardiac arrest: a 16-year retrospective cohort study

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