In-hospital cardiac arrest resuscitation performed by the hospital emergency team: A 6-year retrospective register analysis at Danderyd University Hospital, Sweden

Abstract

Background: Cardiac arrest requires rapid and effective handling. Huge efforts have been implemented to improve resuscitation of sudden cardiac arrest patients. Guidelines around the various parts of effective management, the chain of survival, are available. The aim of the present retrospective study was to study sudden in-hospital cardiac arrest (IHCA) and the outcomes of emergence team resuscitation in a university hospital in Sweden. Methods: The Swedish Cardiopulmonary Resuscitation Registry was used to access all reported cases of IHCA at Danderyd Hospital from 2012 through 2017. Return of spontaneous circulation (ROSC), discharge alive, 30-day mortality and Cerebral Performance Scales score (CPC) were analysed. Results: 574 patients with cardiac arrests were included in the study: 307 patients (54%) had ROSC; 195 patients (34%) were alive to be discharged from hospital; and 191 patients (33%) were still alive at day-30 after cardiac arrest. Witnessed cardiac arrests, VT/VF as initial rhythm and experiencing cardiac arrest in high monitored wards were factors associated with success. However, 53% of patients’ alive at day-30 had a none-shockable rhythm, 16% showed initially a pulseless electrical activity and 37% asystole. CPC score was available for 188 out of the 195 patients that were alive to be discharged: 96.5% of patients where data was available had a favourable neurological outcome, a CPC-score of 1 or 2 at discharge, and only 6 of these patients had a CPC-score of 3 or higher (3%). Conclusions: One third of patients with sudden IHCA were discharged from hospital and alive at day-30, a clear majority without cognitive deficit related to the cardiac arrest. High monitored care, witnessed cardiac arrest and shockable rhythm were factors associated with high success; however, more than half of surviving patients had initially a none-shockable rhythm.

Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey

“…Although the ROSC and 24-hour survival rates in our study (70% and 50%, respectively) were higher than those reported by another study conducted in Turkey 13 years ago (49.3% and 28.5%, respectively), the discharge survival rate was lower in our study (9.7% vs. 13.4%) 4. However, discharge survival rates range between 0% and 42% in the literature, and large-scale studies have reported rates of approximately 20% 7,8,21. We think that a higher proportion of patients over the age of 65 years, CCI scores of ≥6 associated with underlying chronic diseases, and CPR durations of >20 minutes might be important factors contributing to the lower discharge and long-term survival rates in our study.…”

“…Despite significant improvements in the field of cardiopulmonary resuscitation (CPR) over the past 40 years, disparate results have been reported in the literature on survival rates after in-hospital cardiac arrest (IHCA) 1–6. In addition to immediate CPR by trained personnel, the primary or comorbid diseases of the patient are important in long-term survival after IHCA 7,8…”

European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe

“…Thus, it is not surprising that reports on ROSC and survival to hospital discharge or 30-day survival vary considerably. 9,115À118,134À137 The chance of ROSC varies from 36% 117 to 54% 135 and the chance of survival to discharge/30 days varies from 15% 117 to 34%. 135…”

Clinical outcomes of in-hospital cardiac arrest in a tertiary hospital and factors related to 28-day survival: A retrospective cohort study

“…The ROSC rate ranges from 35.7% to 54.0% in different patient cohorts. [ 2 3 5 11 12 13 ] We found that coexisting comorbidities, including CKD and COPD, were the independent risk factors related to ROSC. A previous study revealed that patients who did not have comorbidities included in CCI have a higher survival rate.…”