In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival
- 3.7k Downloads
Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival.
Results and conclusions
The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25–35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
KeywordsCardiac arrest Heart arrest Cardiopulmonary resuscitation Advanced cardiac life support Sudden cardiac death
- 1.Anonymous (1987) Life-sustaining tecnologies and the elderly. United States Congress Office of Technology Assessment, p 11Google Scholar
- 4.Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58:297–308PubMedCrossRefGoogle Scholar
- 5.Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S (1997) Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’. American Heart Association. Circulation 95:2213–2239PubMedGoogle Scholar
- 6.Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. Resuscitation 63:233–249PubMedCrossRefGoogle Scholar
- 43.Stiell IG, Wells GA, Field BJ, Spaite DW, De Maio VJ, Ward R, Munkley DP, Lyver MB, Luinstra LG, Campeau T, Maloney J, Dagnone E (1999) Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA 281:1175–1181PubMedCrossRefGoogle Scholar
- 50.FitzGerald JD, Wenger NS, Califf RM, Phillips RS, Desbiens NA, Liu H, Lynn J, Wu AW, Connors AF Jr, Oye RK (1997) Functional status among survivors of in-hospital cardiopulmonary resuscitation. SUPPORT Investigators Study to Understand Progress and Preferences for Outcomes and Risks of Treatment. Arch Intern Med 157:72–76PubMedCrossRefGoogle Scholar
- 61.Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O'Hearn N, Wigder HN, Hoffman P, Tynus K, Vanden Hoek TL, Becker LB (2005) Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation 111:428–434PubMedCrossRefGoogle Scholar
- 74.Polderman KH SF, van Zanten AR, Uray T, Losert H, De Waal R, Girbes AR, Holzer M (2003) Induced hypothermia improves neurological outcome in asystolic patients with out-of-hospital cardiac arrest. Circulation 108:581Google Scholar
- 76.Laver SR, Padkin A, Atalla A, Nolan JP (2006) Therapeutic hypothermia after cardiac arrest. A survey of practice in intensive care units in the United Kingdom. Anaesthesia (in press)Google Scholar