A performance improvement-based resuscitation programme reduces arrest incidence and increases survival from in-hospital cardiac arrest

Davis, Daniel P.; Graham, Patrick; Husa, Ruchika; Lawrence, Brenna; Minokadeh, Anushirvan; Altieri, Katherine; Sell, Rebecca

doi:10.1016/j.resuscitation.2015.04.008

Cited by 39 publications

(41 citation statements)

References 21 publications

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“…We are unable to examine the impact of rapid response on day of arrest, but have shown a decrease in incidence with our system. 11 On a national level, both survival and neurological outcomes after in-hospital cardiac arrest have improved over the last decade, likely due to earlier recognition and improved resuscitation care. Cardiac arrests can be avoided with early recognition and should be part of protocols implemented in order to intervene at earlier clinical time points before progression to a cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

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Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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Objective Define the frequency and survival pattern of cardiac arrests in relation to the hospital day of event and etiology of arrest. Subject and methods Retrospective cohort study of adult in-hospital cardiac arrests between July 1, 2005, and June 30, 2013, that were classified by etiology of deterioration. Arrests were divided based on hospital day (HD) of event (HD1, HD2–7, HD>7 days), and analysis of frequency was performed. The primary outcome of survival to discharge and secondary outcomes of return of spontaneous circulation (ROSC) and favorable neurological outcomes were compared using multivariable logistic regression analysis. Results A total of 627 cases were included, 193 (30.8%) cases in group HD1, 206 (32.9%) in HD2–7, and 228 (36.4%) in HD>7. Etiology of arrest demonstrated variability across the groups (p < 0.001). Arrests due to ventilation issues increased in frequency with longer hospitalization (p < 0.001) while arrests due to dysrhythmia had the opposite trend (p = 0.014). Rates of survival to discharge (p = 0.038) and favorable neurological outcomes (p = 0.002) were lower with increasing hospital days while ROSC was not different among the groups (p = 0.183). Survival was highest for HD1 (HD1: 38.9% [95% CI, 32.0–45.7%], p = 0.002 vs HD2–7: 34.0% [95% CI, 27.5–40.4%], p < 0.001 vs HD>7: 27.2% [95% CI, 21.4–33.0%], p < 0.001). Conclusions The etiology of cardiac arrests varies in frequency as length of hospitalization increases. Survival rates and favorable neurological outcomes are lower for in-hospital arrests occurring later in the hospitalization, even when adjusted for age, sex, and location of event. Understanding these issues may help with focusing therapies and accurate prognostication.

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Section: Discussionmentioning

confidence: 99%

“…ART is a resuscitation management program designed for inpatient cardiopulmonary arrests, which is used as an alternative to advanced cardiac life support (ACLS) at UCSD. 11 …”

Section: Methodsmentioning

confidence: 99%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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“…ART is a resuscitation program designed specifically for inpatient cardiac arrest and is used as an alternative to Advanced Cardiac Life Support (ACLS) at UCSD (11). …”

Section: Methodsmentioning

confidence: 99%

Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation

et al. 2017

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Background Inpatient peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is an uncommon but potentially preventable type of cardiac arrest (CA). Limited published data exist describing factors associated with inpatient PICA and patient outcomes. This study identifies risk factors associated with PICA among hospitalized patients emergently intubated out of the operating room and compares PICA to other types of inpatient CA. Methods Retrospective case-control study of patients at our institution over a five-year period. Cases were defined as inpatients emergently intubated outside of the operating room that experienced cardiac arrest within 20 minutes after ETI. The control group consisted of inpatients emergently intubated out of the operating room without CA. Predictors of PICA were identified through univariate and multivariate analysis. Clinical outcomes were compared between PICA and other inpatient CAs, identified through a prospectively enrolled CA registry at our institution. Results 29 episodes of PICA occurred over 5 years, accounting for 5% of all inpatient arrests. Shock index ≥ 1.0, intubation within one hour of nursing shift change, and use of succinylcholine were independently associated with PICA. Sustained ROSC, survival to discharge, and neurocognitive outcome did not differ significantly between groups. Conclusion Patients outcomes following PICA were comparable to other causes of inpatient CA. Potentially modifiable factors were associated with PICA. Hemodynamic resuscitation, optimized staffing strategies, and possible avoidance of succinylcholine were associated with decreased risk of PICA. Clinical trials testing targeted strategies to optimize peri-intubation care are needed to identify effective interventions to prevent this potentially avoidable type of CA.

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“…Resuscitation training is provided for all hospital providers as part of the novel Advanced Resuscitation Training (ART) program, which was initiated in 2007 . Critical care nurses and physicians receive annual training, whereas noncritical care personnel undergo biennial training.…”

Section: Methodsmentioning

confidence: 99%

A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting

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Aguilar

Sell

et al. 2015

Journal of Hospital Medicine

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BACKGROUND In cases of in‐hospital–witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) arrest, it is unclear whether cardiopulmonary resuscitation prior to defibrillation attempt or expedited stacked defibrillation attempt is superior. METHODS Retrospective, observational study of all admitted patients with continuous cardiac monitoring who suffered VF/VT arrest between July 2005 and June 2013. In the stacked shock period (2005–2008), institutional protocols advocated early defibrillation with administration of 3 stacked shocks with brief pauses between each single defibrillation attempt to confirm sustained VF/VT. During the initial chest compression period (2008–2011), the protocol was modified to perform a 2‐minute period of chest compressions prior to each defibrillation, including the initial. In the modified stack shock period (2011–2013), for a monitored arrest, defibrillation attempts were expedited with up to 3 successive shocks administered for persistent VF/VT. In unmonitored arrest, chest compressions and ventilations were initiated prior to defibrillation. The primary outcome measure was survival to hospital discharge. RESULTS Six hundred sixty‐one cardiopulmonary arrests were recorded during the study period, with 106 patients (16%) representing primary VF/VT. The incidence of VF/VT arrest did not vary significantly between the study periods (P= 0.16) Survival to hospital discharge for all primary VF/VT arrest victims decreased, then increased significantly from the stacked shock period to initial chest compression period to modified stacked shock period (58%, 18%, 71%, respectively, P < 0.01). Specific group differences were significant between the initial chest compression versus the stacked and modified stacked shock groups (all P < 0.01). CONCLUSION Data suggest that monitored VF/VT should undergo expeditious defibrillation with use of stacked shocks. Journal of Hospital Medicine 2016;11:264–268. © 2015 Society of Hospital Medicine

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A performance improvement-based resuscitation programme reduces arrest incidence and increases survival from in-hospital cardiac arrest

Cited by 39 publications

References 21 publications

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation

A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting

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