The epidemiology and outcomes of adult in-hospital cardiac arrest in a high-income developing country

Alao, David; Mohammed, Nada A; Hukan, Yaman; Neyadi, Maitha Al; Dababneh, Emad H; Çevik, Arif Alper

doi:10.1016/j.resplu.2022.100220

Cited by 12 publications

(14 citation statements)

References 29 publications

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“…Previous studies have also shown that the level of lactic acid at admission is closely related to the increase of in-hospital mortality in ICU patients [ 26 ], which we also included. Besides, Sequential Organ Failure Assessment (SOFA) is a scoring system to assess the severity of multiple organ dysfunction in ICU patients [ 27 ], and the Glasgow Coma Scale (GCS) is widely used for comatose patients in intensive care [ 28 ]. These two scores are easy to operate and obtain, which also enter our analysis.…”

Section: Methodsmentioning

confidence: 99%

Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study

et al. 2023

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Background Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously. Methods This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors’ differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay. Results A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization (P < 0.001; OR: 1.109; 95% CI: 1.068–1.151). With the age-adjusted CCI incorporated into the predictive model, the area under the receiver operating characteristic curve was 0.794 (CI: 0.773–0.814), showing that the prediction model is effective. Additionally, patients with higher age-adjusted CCI scores stayed longer in the hospital (P = 0.026, 95% CI: 0.056–0.896), but there was no significant difference between patients with varied age-adjusted CCI scores on the days of ICU stay. Conclusion The age-adjusted CCI is a valid indicator to predict death in ICU patients with cardiac arrest, which can offer enlightenment for both theory literatures and clinical practice.

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Section: Methodsmentioning

confidence: 99%

Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study

et al. 2023

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“…Had they been resuscitated, it would have resulted in an IHCA rate of 22.3 per 1,000 annual hospital admissions. Assuming a 40% ROSC rate following resuscitation [ 18 ], an additional 197 patients (40% of 492) would have required post-cardiac arrest care in the ICU. The extra cost of ICU care for these patients would have amounted to 1,536,600 US dollars (3,900 X 2 X 197).…”

Section: Resultsmentioning

confidence: 99%

“…We calculated the intensive care unit (ICU) cost by multiplying the ICU cost per day by the median ICU length of stay (ICU-LOS) for patients with IHCA who achieved return of spontaneous circulation and were admitted to the ICU over the study period, multiplied by the total number of DNR patients who died. We corrected the final cost by 40%, which was the rate of ROSC for IHCA patients in our previous report [ 18 ].…”

Section: Ethical Considerationsmentioning

confidence: 99%

“…Before the policy, and similar to many developing countries, DNR was not practised in the UAE, and all patients who had cardiac arrest were given CPR. An earlier report on In-hospital cardiac arrests in our setting highlighted the impact of a lack of DNR policy on IHCA outcomes [ 18 ]. The do-not-resuscitate policy has now been in operation for two years at our institution.…”

Section: Introductionmentioning

confidence: 99%

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Do-not-attempt resuscitation policy reduced in-hospital cardiac arrest rate and the cost of care in a developing country

Alao,

Abraham,

Mohammed

et al. 2024

Libyan Journal of Medicine

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We aim to study the characteristics and outcomes of patients with a Do-Not-Attempt Resuscitation and to determine its impact on the Cost of In-Hospital Cardiac Arrest. A retrospective study of all adult patients admitted to the hospital from June 2021 to May 2022 who had a Do-Not-Resuscitate order. We abstracted patients’ socio-demographics, physiologic parameters, primary diagnosis, and comorbidities from the electronic medical records. We calculated the potential economic cost using the median ICU length of stay for the admitted IHCA patients during the study period. There were 28,866 acute admissions over the study period, and 788 patients had DNR orders. The median (IQR) age was 71 (55-82) years, and 50.3% were males. The most prevalent primary diagnosis was sepsis, 426 (54.3%), and cancer was the most common comorbidity. More than one comorbidities were present in 642 (80%) of the cohort. Of the DNR patients, 492 (62.4%) died, while 296 (37.6%) survived to discharge. Cancer was the primary diagnosis in 65 (22.2%) of those who survived, compared with 154 (31.3%) of those who died (P = 0.002). Over the study period, 153 patients had IHCA and underwent CPR, with an IHCA rate of 5.3 per 1,000 hospital admissions. Without a DNR policy, an additional 492 patients with cardiac arrest would have had CPR, resulting in an IHCA rate of 22.3 per 1000 hospital admissions. Most DNR patients in our setting had sepsis complicated by multiple comorbidities. The DNR policy reduced our IHCA incidence by 76% and prevented unnecessary post-resuscitation ICU care.

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“…As such, research focusing on immediately available factors that predict mortality would inform about the severity and degree of risk of admitted patients. However, although several studies have assessed such issues in OHCA or IHCA populations [ 15 , 16 , 17 , 18 ] there is scarce literature [ 19 ] on the comparisons of predictive factors in cohorts combining IHCA and OHCA patients from the same institutions who would receive a similar therapeutic and prognostic approach, reducing the effects of heterogeneity in practices on measured outcomes.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Prognostic Factors in a Large Cohort of In-Hospital and Out-of-Hospital Cardiac Arrest Patients

Soloperto,

Magni,

Farinella

et al. 2024

Life

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We investigated independent factors predicting neurological outcome and death, comparing in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. The study was conducted in the mixed 34-bed Intensive Care Department at the Hôpital Universitaire de Bruxelles (HUB), Belgium. All adult consecutive cardiac arrest (CA) survivors were included between 2004 and 2022. For all patients, demographic data, medical comorbidities, CA baseline characteristics, treatments received during Intensive Care Unit stay, in-hospital major complications, and neurological outcome at three months after CA, using the Cerebral Performance Category (CPC) scale, were collected. In the multivariable analysis, in the IHCA group (n = 540), time to return of spontaneous circulation (ROSC), older age, unwitnessed CA, higher lactate on admission, asystole as initial rhythm, a non-cardiac cause of CA, the occurrence of shock, the occurrence of acute kidney injury (AKI), and the presence of previous neurological disease and of liver cirrhosis were independent predictors of an unfavorable neurological outcome. Among patients with OHCA (n = 567), time to ROSC, older age, higher lactate level on admission, unwitnessed CA, asystole or pulseless electrical activity (PEA) as initial rhythm, the occurrence of shock, a non-cardiac cause of CA, and a previous neurological disease were independent predictors of an unfavorable neurological outcome. To conclude, in our large cohort of mixed IHCA and OHCA patients, we observed numerous factors independently associated with a poor neurological outcome, with minimal differences between the two groups, reflecting the greater vulnerability of hospitalized patients.

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The epidemiology and outcomes of adult in-hospital cardiac arrest in a high-income developing country

Cited by 12 publications

References 29 publications

Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study

Age-adjusted Charlson Comorbidity Index as effective predictor for in-hospital mortality of patients with cardiac arrest: a retrospective study

Do-not-attempt resuscitation policy reduced in-hospital cardiac arrest rate and the cost of care in a developing country

A Comparison of Prognostic Factors in a Large Cohort of In-Hospital and Out-of-Hospital Cardiac Arrest Patients

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