Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample

Ravindran, Roshini; Kwok, Chun Shing; Wong, Chun Wai; Siller‐Matula, Jolanta M.; Parwani, Purvi; Velagapudi, Poonam; Fischman, David L.; Alraies, Chadi; Michos, Erin D.; Mamas, Mamas A.

doi:10.1016/j.resuscitation.2020.10.005

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…Increasing evidence has revealed different patient characteristics, major contributing causes of cardiac arrest and resuscitation response times between OHCA and EDCA, so the application of ultrasound in patients with EDCA may need further study [35,36].…”

Section: Ultrasoundmentioning

confidence: 99%

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021

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Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

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Section: Ultrasoundmentioning

confidence: 99%

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021

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“…The incidence of CA is not uncommon, with approximately 140.7 out-of-hospital CA per 100,000 individuals in the United States, compared with 17.16 in-hospital CA per 1,000 hospitalizations (2). The treatment and care for CA patients have made considerable progress in recent years, but the prognosis of this group of patients remains poor, with an in-hospital survival rate of only 28.7% (3,4). Clinicians need to deeply study the pathophysiological mechanism of the occurrence and progression of CA to search for new therapeutic targets.…”

Section: Introductionmentioning

confidence: 99%

Association between prothrombin time-international normalized ratio and prognosis of post-cardiac arrest patients: A retrospective cohort study

Tang

Sun²,

Yu³

et al. 2023

Front. Public Health

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BackgroundCardiac arrest (CA) can activate blood coagulation. This study aimed to explore the potential prognostic value of prothrombin time–international normalized ratio (INR) in post-CA patients.MethodsThe clinical data of eligible subjects diagnosed with CA was extracted from the MIMIC-IV database as the training cohort. Restricted cubic spline (RCS), Kaplan–Meier (K-M) survival curve, and Cox regression analyses were conducted to elucidate the association between the INR and all-cause mortality of post-CA patients. Subgroup analysis, propensity score matching (PSM), and inverse probability of treatment (IPTW) were also conducted to improve stability and reliability. Data of the validation cohort were collected from the eICU database, and logistic-regression analyses were performed to verify the findings of the training cohort.ResultsA total of 1,324 subjects were included in the training cohort. A linear correlation existed between INR and the risk of all-cause death of post-CA patients, as shown in RCS analysis, with a hazard ratio (HR) >1 when INR exceeded 1.2. K-M survival curve preliminarily indicated that subjects with INR ≥ 1.2 presented lower survival rate and shorter survival time, and the high level of INR was independently associated with 30-day, 90-day, 1-year, and in-hospital mortalities, with multivariate-adjusted HR of 1.44 (1.20, 1.73), 1.46 (1.23, 1.74), 1.44 (1.23, 1.69), and 1.37 (1.14, 1.64), respectively. These findings were consistent and robust across the subgroup analysis, PSM and IPTW analyses, and validation cohort.ConclusionsWe systematically and comprehensively demonstrated that elevated INR was associated with increased short- and long-term all-cause mortality of post-CA patients. Therefore, elevated INR may be a promising biomarker with prognosis significance.

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“…Cardiac arrest (CA) is not uncommon worldwide, approximately 292,000 adults suffer an in-hospital cardiac arrest (IHCA) 1 , and 420,000 people suffer an out-of-hospital cardiac arrest (OHCA) in the United States each year 2 . Recently, one study based on the nationwide emergency department sample of the United States found that the in-hospital survival rate for all CA was only 28.7%, in addition, the incidence of CA is increasing year by year 3 . Lactate, a product of anaerobic glycolysis under tissue ischemia, is generally elevated in patients with sudden cardiac death, and its level increases with the duration of ischemia and hypoxia 9 .…”

Section: Introductionmentioning

confidence: 99%

The association between anion gap and in-hospital mortality of post-cardiac arrest patients: a retrospective study

Dai

Yang

Wang

et al. 2022

Sci Rep

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We aimed to determine the association between anion gap and in-hospital mortality in post-cardiac arrest (CA) patients. Extracted the data of patients diagnosed with CA from MIMIC-IV database. Generalized additive model (GAM), Cox regression and Kaplan–Meier survival analysis were used to demonstrate the association between AG levels and in-hospital mortality. ROC curve analysis for assessing the discrimination of AG for predicting in-hospital mortality. Totally, 1724 eligible subjects were included in our study finally. 936 patients (551 males and 385 females) died in hospital, with the prevalence of in-hospital mortality was 54.3%. The result of the Kaplan–Meier analysis showed that the higher value of AG had significant lower survival possibility during the hospitalization compared with the lower-value of AG patients. In the crude Cox regression model, high-level of AG subjects was associated with significant higher HR compared with low-level of AG subjects. After adjusted the vital signs data, laboratory data, and treatment, high-level of AG (group Q3 and group Q4) were also associated with increased risk of in-hospital mortality compared with low-level of AG group, 1.52 (95% Cl 1.17–1.85; P < 0.001), 1.64 (95% Cl 1.21–2.08; P < 0.001), respectively. The ROC curve indicated that AG has acceptable discrimination for predicting in-hospital mortality. The AUC value was found to be 0.671 (95% CI 0.646–0.698). Higher AG levels was associated with poor prognosis in post-CA patients. AG is a predictor for predicting in-hospital mortality of CA, and could help refine risk stratification.

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Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample

Cited by 13 publications

References 21 publications

Qualitative and quantitative analysis of emergency department cardiac arrest publications

Qualitative and quantitative analysis of emergency department cardiac arrest publications

Association between prothrombin time-international normalized ratio and prognosis of post-cardiac arrest patients: A retrospective cohort study

The association between anion gap and in-hospital mortality of post-cardiac arrest patients: a retrospective study

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