In-Hospital Cardiac Arrest: Different Wards Show Different Survival Patterns

Abstract

The purpose of the study was to investigate the characteristics and outcomes of in-hospital cardiac arrests that occurred outside of the hospital critical care areas. A prospective register of adult in-hospital cardiac arrests occurring in non-critical care areas of Christchurch Hospital, Christchurch, New Zealand, from January 2001 to December 2004 was compiled. Two-hundred-and-forty-three cardiac arrests were recorded in this period. The overall return of spontaneous circulation was 38.7% (CI 32.6, 44.8) and survival to discharge was 21.0% (CI 15.9, 26.1). Comparison of clinical areas showed that the percentage with successful resuscitation and the percentage with survival to discharge were highest in the cardiology wards (52.2%, 41.3%) and lowest in the medical wards (24.9%, 8.8%). After taking account of rhythm, age, gender and time of day, differences between clinical areas were slightly reduced. Cardiology wards, however, still had a higher resuscitation percentage than medical wards (P=0.03) and a higher percentage with survival to discharge than all other areas (P =0.005 overall, P ≤0.05 for each individual comparison). Reporting of hospital-wide survival rates does not accurately reflect the survival rates in a variety of specific clinical areas. The analysis of outcomes across different clinical areas at Christchurch Hospital revealed differences in outcomes and therefore the clinical experience of staff in those areas. These differences have implications for the resuscitation training of health professionals. The further development of national resuscitation registries may allow more specific analysis of outcomes in different clinical areas.

Survival from in‐hospital cardiac arrest in Auckland City Hospital

“…Survival was fourfold for patients with these rhythms compared with the rate for patients with non‐VT/VF rhythms. This is consistent throughout most studies of in‐hospital arrest 2,8,14,21,28,30,34,35,37–42 …”

“…We chose these times to reflect the level of senior medical staffing available in the location at the time of arrest 43 . Other authors have compared week days with weekends or divided days into 8 h blocks and found similar results 12,21,25,29,32,44,45 . We believe our definition more accurately reflects the clinical situation than a simple division based on time, especially as some areas have a more constant senior medical presence.…”

“…For VT/VF arrests, having the CAT off site was the only independent predictor of delayed defibrillation, despite the provision of AED on these wards and training staff in their use. We believe it is important when comparing reports of in‐hospital cardiac arrest that any differences in delivery of ACLS interventions at different sites within an institution is recognized and reported, to enable more reliable comparisons 3,21,33 …”

“…43 Other authors have compared week days with weekends or divided days into 8 h blocks and found similar results. 12,21,25,29,32,44,45 We believe our definition more accurately reflects the clinical situation than a simple division based on time, especially as some areas have a more constant senior medical presence. This 'After-Hours' effect remained statistically significant after adjustment for other variables and was seen in both wards where the CAT was called and where the CAT is on site.…”

“…This is consistent throughout most studies of in-hospital arrest. 2,8,14,21,28,30,34,35,[37][38][39][40][41][42] The 'After-Hours' effect Survival to discharge was twice as likely for patients that suffered cardiac arrest 'In-Hours' compared with 'After-Hours'. We chose these times to reflect the level of senior medical staffing available in the location at the time of arrest.…”