Predictors of survival and good neurological outcomes after in-hospital cardiac arrest

Objectives: This study aimed to investigate the effect of the code blue activation system and factors affecting patients’ survival to discharge and neurologic outcomes after in-hospital cardiac arrest.

Methods: We retrospectively reviewed the data of patients aged ≥ 18 years who experienced in-hospital cardiac arrest between July 2014 and September 2019 at a tertiary hospital. The outcomes included survival to hospital discharge and neurologic outcomes (cerebral performance category score).

Results: In total, 605 patients were included. The rate of survival to discharge was 21.8%(n = 132), and the rate of sustained return of spontaneous circulation was 69.7% (n = 422). Predisposing conditions, such as sepsis, cancer, pneumonia, and use of vasopressors, were associated with poor prognosis, and the survival rate was low (P = 0.01). The rate of survival to discharge was higher in patients who underwent defibrillation (odds ratio: 2.48, 95% confidence interval: 1.36-4.53) than in those who did not. The median cardiopulmonary resuscitation (CPR) duration time was 11.0 and 26.5 min in the survival and non-survival groups, respectively (P < 0.01). Code blue activation to CPR team arrival time (advanced cardiovascular life support activation time) was not significantly different within 1 minute in both groups (P = 0.95). Similarly, no differences in basic life support activation time and first time to defibrillation were observed between the survival and non-survival groups. Among survivors, factors affecting favorable neurologic outcomes were young age, cerebral performance before CPR, whether witnessed, admission days, and CPR duration.

Conclusions: The compulsory availability of a systematic code blue activation is not sufficient. Further, appropriate monitoring and continuous observation are crucial for improving survival to discharge and neurologic outcomes and preventing cardiac arrest in high-risk patients.

Cardiac arrest; Cardiopulmonary resuscitation; Survival; Code blue; Cardiac life support

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