In-Hospital Cardiac Arrest

Abstract

IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

Re: Patient specific advice for in‐hospital cardiac arrest survival rates

“…However, they are similar to those reported for Australia and New Zealand. 3 We agree there are many factors that influence survival, and variation in cohort characteristics can have a significant impact. We are hopeful that any readers of our letter would refer to the original paper published in Resuscitation to consider how applicable these data are for their own patients.…”

“…However, the survival rates published in table 1 are much higher than that noted in the literature. 2,3 In an earlier publication commenting on the same data, the authors acknowledge that their shortterm survival statistics are better than that of national registries based in the United States and the United Kingdom, and attribute this to the location of care delivery, namely regional versus metropolitan care centers. 4 However, these differences likely go beyond the location of care.…”

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

“…To prevent IHCA the key Open access element is identification of at-risk patients in combination with early interventions to prevent deterioration to cardiac arrest. 20 If patients with risk of pulmonary aspiration of gastric content can be identified and targeted interventions applied, some IHCA may be prevented. One measure could be to transfer at-risk patients to a higher level of care.…”

Prostaglandin E1 Attenuates Post-Cardiac Arrest Myocardial Dysfunction via Inhibiting Mitochondria-Mediated Cardiomyocyte Apoptosis

“…Cardiac arrest (CA) poses a signi cant public health burden. Although modern cardiopulmonary resuscitation (CPR) improves the return of spontaneous circulation (ROSC) rate in patients who suffered from CA, the outcome remains poor (Andersen et al, 2019;Neumar, 2016). Signi cant left ventricular systolic and diastolic dysfunction early after ROSC, termed post-cardiac arrest myocardial dysfunction (PAMD), is common (Jentzer et al, 2016).…”