Long-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation ®

Thompson, Laetitia L.; Chan, Paul S.; Tang, Fengming; Nallamothu, Brahmajee K.; Girotra, Saket; Perman, Sarah M.; Bose, Somnath; Daugherty, Stacie L.; Bradley, Steven M

doi:10.1016/j.resuscitation.2017.10.023

Cited by 48 publications

(41 citation statements)

References 18 publications

(21 reference statements)

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“…Late mortality in CPR patients after hospital discharge has emerged as a new problem. Get With The Guidelines-Resuscitation registry data revealed that only 60% of IHCA survivors survived at 1 year [46]. Continuous morbidity and mortality may be attributed to a relatively high frequency of posttraumatic stress disorder, low levels of well-being [47] and cognitive function, and impaired activities of daily living [48] in OHCA survivors.…”

Section: Discussionmentioning

confidence: 99%

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Wang

Chi

et al. 2018

Intensive Care Med

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PurposeCaseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR.MethodsAdult patients who received ECPR in our institution (2006–2016) were classified into groups 1, 2, and 3 (18–65, 65–75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge.ResultsIn total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of < 30, 30–60, and > 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274).ConclusionOn emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5496-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Wang

Chi

et al. 2018

Intensive Care Med

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“…4 Two national registries based in United States and United Kingdom identified lower survival to discharge rates than this study of 24% and 18% respectively. 5,6 These differences suggest patients in regional settings may have better outcomes from IHCA than their metropolitan counterparts. Many patient and arrest characteristics were related to shortterm survival.…”

Section: Short-term Survivalmentioning

confidence: 99%

“…[1][2][3] Previous research identified approximately half of IHCA patients survive the arrest event and half of these survivors live to discharge. [4][5][6] However, long-term survival and its correlates beyond discharge are less well known. 5,[7][8][9][10] The vast majority of IHCA research published from developed countries is based on large metropolitan hospital cohorts.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] However, long-term survival and its correlates beyond discharge are less well known. 5,[7][8][9][10] The vast majority of IHCA research published from developed countries is based on large metropolitan hospital cohorts. This is despite the importance of regional hospitals as referral centres for geographically dispersed rural populations.…”

Section: Introductionmentioning

confidence: 99%

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Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

et al. 2019

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Introduction: Evidence about the immediate survival from in-hospital cardiac arrest (IHCA) is well established, however, beyond discharge there is very little describing the long-term outcomes of these patients. Of the few existing studies, all have been conducted in metropolitan centres. Therefore, this study describes survival from IHCA in both the short and long-term in a large regional hospital cohort. Method: A retrospective cohort study was conducted including all adult patients who suffered an IHCA between 1 February 2000 and 31 December 2017 in a large regional (non-metropolitan) hospital in Victoria, Australia. Characteristics of the arrest and patient were sourced from a prospectively collected database that captures all of the arrests occurring in the hospital. Mortality data after discharge were sourced from the state death registry, censored on 31 January 2018. Results: A total of 629 patients were included in the study. Of these, 357 (57%) survived the event, and 213 (34%) survived to discharge. At one-year post-arrest 27% of the original cohort were still alive. The age of the patient, arrest rhythm, location and duration of resuscitation were all significantly associated with long-term survival. Conclusion: Both short and long-term survival following an IHCA in a regional hospital are similar to previously described rates in metropolitan hospitals. Further research is required on the post-discharge correlates of long-term survival.

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“…Despite modest improvement in survival over recent years, in-hospital cardiac arrest remains a leading cause of death, with ≈300,000 inhospital cardiac arrest events per year in the United States. 1,2 Although conventional classification of cardiac arrest distinguishes between outof-hospital cardiac arrest and in-hospital cardiac arrest, less focus has been placed on patients who develop cardiac arrest in the emergency department before admission to inpatient services.…”

Section: Introductionmentioning

confidence: 99%

Predicting cardiac arrest in the emergency department

2020

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In‐hospital cardiac arrest remains a leading cause of death: roughly 300,000 in‐hospital cardiac arrests occur each year in the United States, ≈10% of which occur in the emergency department. ED‐based cardiac arrest may represent a subset of in‐hospital cardiac arrest with a higher proportion of reversible etiologies and a higher potential for neurologically intact survival. Patients presenting to the ED have become increasingly complex, have a high burden of critical illness, and face crowded departments with thinly stretched resources. As a result, patients in the ED are vulnerable to unrecognized clinical deterioration that may lead to ED‐based cardiac arrest. Efforts to identify patients who may progress to ED‐based cardiac arrest have traditionally been approached through identification of critically ill patients at triage and the identification of patients who unexpectedly deteriorate during their stay in the ED. Interventions to facilitate appropriate triage and resource allocation, as well as earlier identification of patients at risk of deterioration in the ED, could potentially allow for both prevention of cardiac arrest and optimization of outcomes from ED‐based cardiac arrest. This review will discuss the epidemiology of ED‐based cardiac arrest, as well as commonly used approaches to predict ED‐based cardiac arrest and highlight areas that require further research to improve outcomes for this population.

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Long-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation ®

Abstract: Among Medicare beneficiaries in the GWTG-Resuscitation registry, 1-year survival after IHCA has increased for over the past decade. Temporal improvements in survival were noted for both shockable and non-shockable presenting arrest rhythms.

Cited by 48 publications

References 18 publications

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

Predicting cardiac arrest in the emergency department

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