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
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