In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response

Sandroni, Claudio; Ferro, Giorgia; Santangelo, Susanna; Tortora, Francesca; Mistura, Lorenza; Cavallaro, Fabio; Caricato, Anselmo; Antonelli, Massimo

doi:10.1016/j.resuscitation.2004.03.020

Cited by 172 publications

(99 citation statements)

References 20 publications

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“…[8][9][10] In addition, the incidence of IHCA has been reported as 1-4 arrests per 1,000 patient admissions. 4,11,12 However, there are few studies on the epidemiology and clinical outcomes of IHCA cases in general wards. Also, the response to IHCA in general wards is expected to be less efficient than in the ICU because of delayed diagnosis, poor monitoring, and the lack of equipment and well trained staff.…”

Section: Introductionmentioning

confidence: 99%

“…Also, the response to IHCA in general wards is expected to be less efficient than in the ICU because of delayed diagnosis, poor monitoring, and the lack of equipment and well trained staff. 3,[12][13][14] A paper by Brady et al reported that patients who have witnessed and/or monitored cardiac arrest have a significantly higher rate of survival to hospital discharge than patients whose cardiac arrest is neither monitored nor witnessed. 15 We hypothesized that survival to hospital discharge after IHCA would be significantly different for patients in general wards than those in ICUs.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Witnessed and Monitored Cases of In-Hospital Cardiac Arrest in the General Ward of a University Hospital in Korea

et al. 2013

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The main outcomes included survival to hospital discharge, incidence of IHCA, and prognostic factors related to hospital mortality. We also investigated preventable cases. RESULTS: We identified 238 index cases of IHCA. The average incidence of IHCA was 0.145 IHCAs per 1,000 patient admissions. Survival to hospital discharge was 19% (46 cases), 66% of which were due to non-cardiac causes, and 77% were due to medical illnesses. The most common first documented rhythm was pulseless electrical activity (38%). Two hundred three cases (85.3%) of IHCA were witnessed at the event; 135 cases (56.7%) were monitored at the event. Non-witnessed cases, monitored cases, night onset, medical illness, metastatic cancer, intubation, and long duration of cardiopulmonary resuscitation were significantly associated with hospital mortality. We identified 91 preventable cases (38%). Respiratory insufficiency (37 cases, 41%) was one of major cause of preventable IHCA. CONCLUSIONS: Witnessed IHCAs in the general ward had a higher rate of survival to hospital discharge; however, monitored cases had a lower rate of survival to hospital discharge. Respiratory insufficiency was a major preventable cause of IHCA. In consideration of the preventable IHCAs, further studies should be performed on monitoring practices in general wards.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Witnessed and Monitored Cases of In-Hospital Cardiac Arrest in the General Ward of a University Hospital in Korea

et al. 2013

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“…Despite numerous studies indicating long-term patient outcomes are poor following cardiac resuscitation in the hospital, the benefits of early intervention have sometimes been overlooked. [2][3][4][5] Several observational studies and a retrospective analysis that included the Medical Emergency Response Improvement Team (MERIT) in Pittsburgh showed that introduction of a MET apparently has the potential to decrease the incidence of unanticipated intensive care unit (ICU) admissions and in-hospital morbidity and mortality from unexpected cardiopulmonary arrest. 6 -9 Furthermore, the use of a MET as a quality improvement tool to detect medical errors and effect systemwide interventions is promising.…”

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confidence: 99%

Establishing a rapid response team (RRT) in an academic hospital: One year's experience

King

Horvath

Shulkin

2006

Journal of Hospital Medicine

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BACKGROUNDRapid response teams and medical emergency teams have been utilized to rapidly manage seriously ill patients at risk of cardiopulmonary arrest and other high‐risk conditions but have not been extensively described in the American medical literature.OBJECTIVESTo describe a full year's experience of implementing a rapid response team (RRT) in an academic medical center.DESIGNRetrospective analysis of our hospital's RRT database and description of the implementation process from July 2004 to July 2005.SETTINGUrban, academic medical center.RESULTSThe RRT system was activated for 307 potentially unstable patients. The most common reasons for an RRT activation were cardiac, respiratory, and neurological conditions. At least 37% of RRT calls were for off‐unit inpatients and to outpatient/common areas frequented by outpatients and visitors, whereas at least 42% occurred in inpatient units. Most RRT calls, 82.9%, occurred during daytime hours. In the opinion of RRT leaders 98% of the evaluated calls were appropriate and 85% of the RRT responses resulted in the prevention of further clinical deterioration.CONCLUSIONSAn RRT was introduced into an academic medical center, and the results suggested it is capable of preventing clinical deterioration in unstable patients and may have the potential to decrease the frequency of cardiac arrests. The RRT also may fill a gap in patient safety by enabling rapid triage and expedited treatment of off‐unit inpatients, outpatients, and visitors. The keys to the early success of our implementation of an RRT were multidisciplinary input and improvements made in real time. Journal of Hospital Medicine 2006;1:296–305. © 2006 Society of Hospital Medicine.

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“…Multiple prior studies have suggested that survival after in-hospital CPR is higher when CPR is received in monitored settings [11][12][13][14]. Our findings of worse outcomes in monitored ventilated patients can be fully explained by the fact that these prior studies did not restrict their analyses to ventilated patients, who have a much higher severity of illness than non-ventilated patients.…”

Section: Discussionmentioning

confidence: 68%

Cardiopulmonary Resuscitation Among Mechanically Ventilated Patients

Alalwan¹,

Ehlenbach²,

Young³

et al. 2012

C105. Ethics and End of Life Care in the Intensive Care Unit

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Purpose-To evaluate the outcomes, including long term survival, after CPR in mechanically ventilated patients.Methods-We analyzed Medicare data from 1994-2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated (defined by ICD-9 procedure code for intubation [96.04] Results-We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4% (95% confidence interval [CI] 18.3-18.5%). Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1% (95% CI 9.8%-10.4%), compared to 19.2% (95% CI 19.1%-19.3%) in non-ventilated patients (p<0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52% lower odds of survival (OR 0.48, 95% CI 0.46-0.49, p<0.001). Median long term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95% CI 5.3-6.8 months), compared to 19.0 months (95% CI 18.6-19.5 months) among the non-ventilated survivors (p=<0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1% were alive at one year. Conclusions-Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.

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In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response

Cited by 172 publications

References 20 publications

Clinical Outcomes of Witnessed and Monitored Cases of In-Hospital Cardiac Arrest in the General Ward of a University Hospital in Korea

Clinical Outcomes of Witnessed and Monitored Cases of In-Hospital Cardiac Arrest in the General Ward of a University Hospital in Korea

Establishing a rapid response team (RRT) in an academic hospital: One year's experience

Cardiopulmonary Resuscitation Among Mechanically Ventilated Patients

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