Predictors of survival and good neurological outcomes after in-hospital cardiac arrest
1Department of Emergency Medicine, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
2Department of Emergency Medicine, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea
DOI: 10.22514/sv.2021.009 Vol.17,Issue 2,March 2021 pp.67-76
Published: 08 March 2021
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
Min Jee Lee,Ji Ho Ryu,Mun Ki Min,Dae Sup Lee,Seok Ran Yeom,Byung kwan Bae,Young Mo Cho,Soon Chang Park. Predictors of survival and good neurological outcomes after in-hospital cardiac arrest. Signa Vitae. 2021. 17(2);67-76.
 Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S337-S357.
 McEvoy MD, Field LC, Moore HE, Smalley JC, Nietert PJ, Scarbrough SH. The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation. 2014; 85: 82-87.
 Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: adult advanced cardiovascular life support. Circulation. 2015; 132: S444-S464.
 Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, et al. Part 4: systems of care and continuous quality improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132: S397-S413.
 Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: adult basic life support and cardiopulmonary resus-citation quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132: S414-S435.
 Carrick RT, Park JG, McGinnes HL, Lundquist C, Brown KD, Janes WA, et al. Clinical predictive models of sudden cardiac arrest: a survey of the current science and analysis of model performances. Journal of the American Heart Association. 2020; 9: e017625.
 Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Vaillancourt C, et al. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis. British Medical Journal. 2019; 367: 16373.
 Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Medicine. 2007; 33: 237-245.
 Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58: 297-308.
 Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002; 54: 115-123.
 Schein RMH, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990; 98: 1388-1392.
 Yoon H, Kwon Y, An J, Hong S, Kim YT. Main outcomes of the sudden cardiac arrest survey 2006 to 2016. Clinical and Experimental Emergency Medicine. 2019; 6: 183-188.
 Choi Y, Kwon IH, Jeong J, Chung J, Roh Y. Incidence of adult in-hospital cardiac arrest using national representative patient sample in Korea. Healthcare Informatics Research. 2016; 22: 277.
 Nolan JP, Berg RA, Andersen LW, Bhanji F, Chan PS, Donnino MW, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry template for in-hospital cardiac arrest: a consensus report from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia). Circulation. 2019; 140: e746-e757.
 Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: a review. . Journal of the American Medical Association. 2019; 321: 1200-1210.
 Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circulation. Cardiovascular Quality and Outcomes. 2019; 12: e005580.
 Merchant RM, Yang L, Becker LB, Berg RA, Nadkarni V, Nichol G, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States*. Critical Care Medicine. 2011; 39: 2401-2406.
 Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018; 137: e67-e492.
 Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. New England Journal of Medicine. 2012; 367: 1912-1920.
 Chon GR, Lee J, Shin Y, Huh JW, Lim C-, Koh Y, et al. Clinical outcomes of witnessed and monitored cases of in-hospital cardiac arrest in the general ward of a university hospital in Korea. Respiratory Care. 2013; 58: 1937-1944.
 Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation. 2016; 107: 19-24.
 Ebell MH, Afonso AM. Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis. Family Practice. 2011; 28: 505-515.
 Chan PS, Spertus JA, Krumholz HM, Berg RA, Li Y, Sasson C, et al. A validated prediction tool for initial survivors of in-hospital cardiac arrest. Archives of Internal Medicine. 2012; 172: 947.
 Perman SM, Stanton E, Soar J, Berg RA, Donnino MW, Mikkelsen ME, et al. Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes. Journal of the American Heart Association. 2016; 5: e003638.
 Buist MD, Burton PR, Bernard SA, Waxman BP, Anderson J. Recog-nising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Medical Journal of Australia. 1999; 171: 22-25.
 Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Critical Care Medicine. 1994; 22: 244-247.
 Neale G, Woloshynowych M, Vincent C. Exploring the causes of adverse events in NHS hospital practice. Journal of the Royal Society of Medicine. 2001; 94: 322-330.
 Lee BY, Hong S. Rapid response systems in Korea. Acute and Critical Care. 2019; 34: 108-116.
 Girotra S, Cram P, Spertus JA, Nallamothu BK, Li Y, Jones PG, et al. Hospital variation in survival trends for in-hospital cardiac arrest. Journal of the American Heart Association. 2014; 3: e000871.
 Brady WJ, Gurka KK, Mehring B, Peberdy MA, O’Connor RE. In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation. 2011; 82: 845-852.
 Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. New England Journal of Medicine. 2008; 358: 9-17.
 Krishna CK, Showkat HI, Taktani M, Khatri V. Out of hospital cardiac arrest resuscitation outcome in North India -CARO study. World Journal of Emergency Medicine. 2017; 8: 200-205.
 Chan PS, Berg RA, Tang Y, Curtis LH, Spertus JA. Association between therapeutic hypothermia and survival after in-hospital cardiac arrest. Journal of the American Medical Association. 2016; 316: 1375.
 Chan PS, Nallamothu BK. Improving outcomes following in-hospital cardiac arrest: life after death. Journal of the American Medical Association. 2012; 307: 1917-1918.
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