Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes

Sarah M Perman, Emily Stanton, Jasmeet Soar, Robert A Berg, Michael W Donnino, Mark E Mikkelsen, Dana P Edelson, Matthew M Churpek, Lin Yang, Raina M Merchant, American Heart Association's Get With the Guidelines®—Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators, Graham Nichol, Vinay M Nadkarni, Mary Ann Peberdy, Paul S Chan, Tim Mader, Karl B Kern, Sam Warren, Emilie Allen, Brian Eigel, Elizabeth A Hunt, Joseph P Ornato, Scott Braithwaite, Romergryko G Geocadin, Mary E Mancini, Jerry Potts, Tanya Lane Truitt, Sarah M Perman, Emily Stanton, Jasmeet Soar, Robert A Berg, Michael W Donnino, Mark E Mikkelsen, Dana P Edelson, Matthew M Churpek, Lin Yang, Raina M Merchant, American Heart Association's Get With the Guidelines®—Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators, Graham Nichol, Vinay M Nadkarni, Mary Ann Peberdy, Paul S Chan, Tim Mader, Karl B Kern, Sam Warren, Emilie Allen, Brian Eigel, Elizabeth A Hunt, Joseph P Ornato, Scott Braithwaite, Romergryko G Geocadin, Mary E Mancini, Jerry Potts, Tanya Lane Truitt

Abstract

Background: In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths.

Methods and results: This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed-days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed-days in both locations.

Conclusions: Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.

Keywords: critical care; in‐hospital cardiac arrest; outcome; resuscitation.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Utstein consort diagram. This figure illustrates study inclusion and exclusion criteria. ICU indicates intensive care unit; IHCA, in‐hospital cardiac arrest.
Figure 2
Figure 2
Rate of in‐hospital cardiac arrest/1000 patient bed‐days by location. This figure illustrates the rate of IHCA/1000 patient bed‐days by location per year over the study period. (Data were collected from January 1, 2003 to September 14, 2010, and therefore 2010 is incomplete). IHCA indicates in‐hospital cardiac arrest.
Figure 3
Figure 3
Survival by location over time. This figure illustrates the proportion of patients who survived to discharge after IHCA by location and year over the study period. ICU indicates intensive care unit; IHCA, in‐hospital cardiac arrest.

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DP, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322.
    1. Merchant RM, Berg RA, Yang L, Becker LB, Groenveld PW, Chan PS. Hospital variation in survival after in‐hospital cardiac arrest. J Am Heart Assoc. 2014;3:e000400 doi: .
    1. Girotra S, Chan PS. Trends in survival after in‐hospital cardiac arrest. N Engl J Med. 2013;368:680–681.
    1. Brady WJ, Gurka KK, Mehring B, Peberdy MA, O'Connor RE. In‐hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation. 2011;82:845–852.
    1. Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG. Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ. 2011;183:1589–1595.
    1. Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PWJr, Hoek TV, Halverson CC, Doering L, Peberdy MA, Edelson DP; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular and Stroke Nursing . Strategies for improving survival after in‐hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013;127:1538–1563.
    1. Tian J, Kaufman DA, Zarich S, Chan PS, Ong P, Amoateng‐Adjepong Y, Manthous CA; American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators . Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med. 2010;182:501–506.
    1. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane‐Trultt T. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.
    1. Szklo M, Nieto J. Epidemiology: Beyond the Basics. Burlington, MA: Jones and Bartlett Publishers; 2014.
    1. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In‐hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33:237–245.
    1. Sandroni C, Ferro G, Santangelo S, Tortora F, Mistura L, Cavallaro F, Caricato A, Antonelli M. In‐hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation. 2004;62:291–297.
    1. Tunstall‐Pedoe H, Bailey L, Chamberlain DA, Marsden AK, Ward ME, Zideman DA. Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. BMJ. 1992;304:1347–1351.
    1. Dumot JA, Burval DJ, Sprung J, Walters JH, Mraovic B, Karafa MT, Mascha EJ, Bourke DL. Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitations. Arch Intern Med. 2001;161:1751–1758.
    1. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364:1037–1045.
    1. Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, DeVIta MA, Rosenbaum SH, Rothenberg DM, Sprung CL, Webb SA, Wlody GS, Hurford WE. Recommendations for end‐of‐life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine. Crit Care Med. 2001;29:2332–2348.
    1. The Joint Commission's Annual Report on Quality and Safety. 2008. Available at: . Accessed August 26, 2016.
    1. Chan PS. Rapid response teams. Arch Intern Med. 2010;170:18.
    1. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS; American Heart Association Get with the Guidelines‐Resuscitation Investigators . Trends in survival after in‐hospital cardiac arrest. N Engl J Med. 2012;367:1912–1920.
    1. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients. JAMA. 2002;288:2151.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe