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Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes.

ABSTRACT: BACKGROUND:Despite the high incidence of in-hospital cardiac arrest (IHCA) in US hospitals, the prognosis and end-of-life decision-making patterns of a patient with a recurrent IHCA are unknown. METHODS:Within Get-With-The-Guidelines-Resuscitation, we identified 192,250 patients from 711 hospitals with an IHCA from 2000 to 2015. Patients were categorized as having no recurrent IHCA (only 1 event), recurrent IHCA (?2 IHCAs), and recurrent out-of-hospital cardiac arrest (OHCA), defined as an IHCA after an OHCA. Using multivariable hierarchical logistic regression, rates of survival to discharge and favorable neurological survival (mild or no disability) between the 3 groups were compared. Rates of de novo "do not attempt resuscitation" (DNAR) and withdrawal of care orders among successfully resuscitated patients were also evaluated. RESULTS:Overall, 165,446 (86.1%) had no recurrent IHCA, 23,643 (12.3%) had recurrent IHCA, and 3162 (1.6%) had recurrent OHCA. Compared with patients with no recurrent IHCA, patients with recurrent IHCA were less than half as likely to survive to discharge (12.7% vs 22.1%; adjusted OR: 0.46 [0.44-0.48], P < .001) and have favorable neurological survival (7.0% vs 13.1%; adjusted OR: 0.44 [0.42-0.47], P < .001). Compared with patients with recurrent OHCA, patients with recurrent IHCA also had lower rates of survival to discharge (12.7% vs 16.1%; adjusted OR: 0.81 [0.71-0.94], P = .005) and favorable neurological survival (7.0% vs 8.9%; adjusted OR: 0.66 [0.54-0.81], P < .001). Despite worse survival outcomes, patients with recurrent IHCA were least likely to adopt DNAR orders within the first 24 hours after successful resuscitation compared with patients with no recurrent IHCA or recurrent OHCA (17.2% vs 18.9% and 26.6%, respectively) or withdraw care at any time (17.7% vs 24.4% and 31.2%, respectively). CONCLUSIONS:Nearly 1 in 8 patients with an IHCA has a recurrent IHCA, and these patients have worse outcomes than patients with only a single IHCA and those with an IHCA after being hospitalized for an OHCA. Despite worse survival, rates of DNAR and withdrawal of care were lowest for patients with recurrent IHCA. These findings provide important prognostic information for clinicians caring for patients with recurrent IHCA and suggest the need to better align resuscitation and end-of-life decisions with patients' prognoses after IHCA.

SUBMITTER: Chan ML

PROVIDER: S-EPMC6312851 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes.

Chan Maya L ML Spertus John A JA Tang Yuanyuan Y Starks Monique Anderson MA Chan Paul S PS

American heart journal 20180509

<h4>Background</h4>Despite the high incidence of in-hospital cardiac arrest (IHCA) in US hospitals, the prognosis and end-of-life decision-making patterns of a patient with a recurrent IHCA are unknown.<h4>Methods</h4>Within Get-With-The-Guidelines-Resuscitation, we identified 192,250 patients from 711 hospitals with an IHCA from 2000 to 2015. Patients were categorized as having no recurrent IHCA (only 1 event), recurrent IHCA (≥2 IHCAs), and recurrent out-of-hospital cardiac arrest (OHCA), defi ...[more]

PMID: 29859617

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Project description:ObjectivesThe objective of this study was to associate ventilation rates during in-hospital cardiopulmonary resuscitation with 1) arterial blood pressure during cardiopulmonary resuscitation and 2) survival outcomes.DesignProspective, multicenter observational study.SettingPediatric and pediatric cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.PatientsIntubated children (≥ 37 wk gestation and < 19 yr old) who received at least 1 minute of cardiopulmonary resuscitation.InterventionsNone.Measurements and main resultsArterial blood pressure and ventilation rate (breaths/min) were manually extracted from arterial line and capnogram waveforms. Guideline rate was defined as 10 ± 2 breaths/min; high ventilation rate as greater than or equal to 30 breaths/min in children less than 1 year old, and greater than or equal to 25 breaths/min in older children. The primary outcome was survival to hospital discharge. Regression models using Firth penalized likelihood assessed the association between ventilation rates and outcomes. Ventilation rates were available for 52 events (47 patients). More than half of patients (30/47; 64%) were less than 1 year old. Eighteen patients (38%) survived to discharge. Median event-level average ventilation rate was 29.8 breaths/min (interquartile range, 23.8-35.7). No event-level average ventilation rate was within guidelines; 30 events (58%) had high ventilation rates. The only significant association between ventilation rate and arterial blood pressure occurred in children 1 year old or older and was present for systolic blood pressure only (-17.8 mm Hg/10 breaths/min; 95% CI, -27.6 to -8.1; p < 0.01). High ventilation rates were associated with a higher odds of survival to discharge (odds ratio, 4.73; p = 0.029). This association was stable after individually controlling for location (adjusted odds ratio, 5.97; p = 0.022), initial rhythm (adjusted odds ratio, 3.87; p = 0.066), and time of day (adjusted odds ratio, 4.12; p = 0.049).ConclusionsIn this multicenter cohort, ventilation rates exceeding guidelines were common. Among the range of rates delivered, higher rates were associated with improved survival to hospital discharge.

Project description:BackgroundMaternal in-hospital cardiac arrest is a rare event with the potential for resuscitation treatment delays because of the difficulty accessing hospital obstetrical units and limited simulation training or resuscitation experience of obstetrical staff. However, it is unclear whether survival rates and processes of care differ between women with a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac arrest.ObjectiveWe aimed determine whether to there are delays in process measures and differences in survival outcomes between pregnant and nonpregnant women who have in-hospital cardiac arrest.Study designUsing data from 2000 to 2019 in the Get With The Guidelines-Resuscitation registry, we compared resuscitation outcomes between women aged 18 to 50 years with a maternal or nonmaternal in-hospital cardiac arrest. Using a nonparsimonious propensity score, we matched patients with a maternal in-hospital cardiac arrest to as many as 10 women with a nonmaternal in-hospital cardiac arrest. We constructed conditional logistic regression models to compare survival outcomes (survival to discharge, favorable neurologic survival [discharge cerebral performance score of 1], and return of spontaneous circulation) and processes of care (delayed defibrillation [>2 minutes] and administration of epinephrine [>5 minutes]) between women with a maternal in-hospital cardiac arrest vs those with a nonmaternal in-hospital cardiac arrest.ResultsOverall, 421 women with a maternal in-hospital cardiac arrest were matched by propensity score to 2316 women with a nonmaternal in-hospital cardiac arrest. The mean age among propensity score-matched women with a maternal in-hospital cardiac arrest was 31.4 (standard deviation, 6.5) years, where 33.7% were of Black race and 86.9% had an initial nonshockable cardiac arrest rhythm. Unadjusted survival rates were higher in women with a maternal in-hospital cardiac arrest than in women with a nonmaternal in-hospital cardiac arrest: survival to discharge of 45.1% vs 26.5%, survival with cerebral performance category 1 status of 36.1% vs 17.7%, and return of spontaneous circulation of 75.8% vs 70.6%. After adjustment, there was no difference in the likelihood of survival to discharge (odds ratio, 1.19; 95% confidence interval, 0.82-1.73) or return of spontaneous circulation (odds ratio, 0.94; 95% confidence interval, 0.65-1.35) between women with a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac arrest. However, women with a maternal in-hospital cardiac arrest were more likely to have favorable neurologic survival (odds ratio, 1.57; 95% confidence interval, 1.06-2.33). Compared with women with a nonmaternal in-hospital cardiac arrest, women with a maternal in-hospital cardiac arrest had similar rates of delayed defibrillation (42.5% vs 34.4%; odds ratio, 1.14 [95% confidence interval, 0.41-3.18]; P=.31) and delayed administration of epinephrine (13.8% vs 10.6%; odds ratio, 0.96 [95% confidence interval, 0.50-1.86]; P=.09).ConclusionAlthough concerns have been raised about resuscitation outcomes in women with a maternal in-hospital cardiac arrest, the rates of survival and resuscitation processes of care were not worse in women with a maternal in-hospital cardiac arrest.

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Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes.

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Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes.

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