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Intensive Care Medicine

, Volume 33, Issue 2, pp 237–245 | Cite as

In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival

  • Claudio Sandroni
  • Jerry Nolan
  • Fabio Cavallaro
  • Massimo Antonelli
Special Article

Abstract

Design

Review.

Objective

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.

Keywords

Cardiac arrest Heart arrest Cardiopulmonary resuscitation Advanced cardiac life support Sudden cardiac death 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Claudio Sandroni
    • 1
  • Jerry Nolan
    • 2
  • Fabio Cavallaro
    • 1
  • Massimo Antonelli
    • 1
  1. 1.Intensive Care UnitCatholic University School of MedicineRomeItaly
  2. 2.Intensive Care UnitRoyal United HospitalBathUK

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