Abstract:
In-hospital cardiac arrest (IHCA) is a catastrophic complication for patients while admitted in a medical institution. There have been approximately 200,000 hospitalized patients per year treated for cardiac arrest in the United States, with a reported survival to hospital discharge rate of 7-26%.
IHCA patients tend to be sicker, with increased comorbidities, as well as demonstrating a higher rate of non-shockable rhythms [pulseless electrical activity (PEA) or asystole]. Therefore, it is crucial for clinicians to have a thorough understanding of the factors affecting the outcome of inpatient cardiopulmonary resuscitation (CPR).
Several factors, including the initial rhythm, resuscitation duration, underlying comorbidities, time of day, and initial resuscitation effort, may be related to the resuscitation outcome. The majority of the IHCA literature includes participants from Western countries. There is a paucity of IHCA data in the Asian population, which currently ranks as the world's second highest population, behind only Caucasians.
Patient outcomes following IHCA are influenced by several variables, including ethnicity, socioeconomic status, health status, and utilization of healthcare resources. Compared with white patients, survival after IHCA has been shown to be reduced in black patients.9,10 The exiting validated risk model for IHCA from North America may not be suitable to different healthcare systems in an oriental society. Therefore, we conducted this investigation to determine the independent predictors for resuscitation outcomes after IHCA focusing on an oriental population.
Background
In-hospital cardiac arrest (IHCA) is a catastrophic complication for patients while admitted in a medical institution. The outcome of IHCA remains poor, and understanding of the prognostic factors for survival outcome after IHCA is lacking, specifically in an oriental population.
Methods
A retrospective observational cohort study of 382 patients with IHCA who required resuscitation was conducted in an urban tertiary hospital in Taiwan. Return of spontaneous circulation (ROSC) and survival to hospital discharge were the primary outcome measures.
Results
The incidence of IHCA was 3.25 per 1000 admissions. These patients had a mean age of 67.2 ± 21.7 years and were mostly men (66.5%). The rate of successful ROSC was 66%, and the rate of survival to hospital discharge was 11.8%. A stepwise decrease in ROSC was observed with additional resuscitation efforts. Independent predictors for survival to hospital discharge were being female, resuscitation duration of less than20 minutes, and no use of epinephrine during resuscitation. A 68% ROSC success rate and an 84% survival to discharge rate was recorded in patients receiving resuscitation for <30 minutes. Young patients seemed the most likely to benefit from longer resuscitation attempts (>30 minutes), as observed in survival to hospital discharge.
Conclusion
Based on data from a single hospital registry in East Asia, a shorter duration of resuscitation was demonstrated to be a predictor of immediate survival with ROSC and survival to hospital discharge.
