Factors associated with shockable versus non-shockable rhythms in patients with in-hospital cardiac arrest

Stanković, Nikola; Høybye, Maria; Holmberg, Mathias J.; Lauridsen, Kasper Glerup; Andersen, Lars W.; Granfeldt, Asger

doi:10.1016/j.resuscitation.2020.11.022

Cited by 30 publications

(38 citation statements)

References 39 publications

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“…In out-of-hospital cardiac arrest (OHCA) patients, studies have found that increasing age, female sex, prolonged response time, and noncardiovascular comorbidity and medications are associated with an initial non-shockable rhythm. 1À5 Similar findings have been reported in a recent study on in-hospital cardiac arrest (IHCA) patients, 6 although the topic is less thoroughly investigated in this patient population.…”

Section: Introductionsupporting

confidence: 74%

“…19,20 A recent study of IHCA patients utilizing data from DANARREST investigated predictors of shockable vs. non-shockable rhythm. 21 Higher age, female sex, and specific non-cardiovascular comorbidities such as overweight and obesity were associated with an initial non-shockable rhythm. 21 The present study adds to this knowledge by identifying specific predictors of PEA and asystole, addressing them as two separate initial cardiac arrest rhythms.…”

Section: Discussionmentioning

confidence: 99%

“…The design of the current study largely follows that of a previous study examining shockable vs. non-shockable rhythms. 6 In Denmark, ethical approval for observational register-based studies is not required.…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

“…The five-year timeframe was chosen to secure a reasonable time from the diagnoses to cardiac arrest. 6 Comorbidities were defined using the International Classification of Disease System (ICD-10), using validated codes whenever possible. A complete list of ICD-10 codes, including relevant references, is provided in the Supplement (Table S1).…”

Section: Data Sourcesmentioning

confidence: 99%

“…14 The 180-day time-window was chosen to ensure that prescriptions were indicative of active medications only. 6 A complete list of ATC-codes is provided in the Supplement (Table S1).…”

Section: Data Sourcesmentioning

confidence: 99%

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Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes

et al. 2021

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Aim: This observational cohort study aimed to identify factors associated with pulseless electrical activity (PEA) and asystole in in-hospital cardiac arrest (IHCA) patients and to determine whether differences in outcome based on the initial rhythm were explained by patient-and cardiac arrest characteristics.Methods: Adults with IHCA from 2017 to 2018 were included from the Danish IHCA Registry (DANARREST). Additional data came from populationbased registries. Unadjusted (RRs) and adjusted risk ratios (aRRs) were estimated for predictors of initial rhythm, return of spontaneous circulation (ROSC), and survival.Results: We included 1495 PEA and 1285 asystole patients. The patients did not differ substantially in patient characteristics. Female sex, age>90 years, pulmonary disease, and obesity were associated with initial asystole. Ischemic heart disease and witnessed and monitored cardiac arrest were associated with initial PEA. In unadjusted and adjusted analyses, PEA was associated with increased ROSC (aRR = 1.21, 95% confidence interval [CI] 1.10; 1.33). PEA was also associated with increased 30-day and 1-year survival in the unadjusted analysis, while there was no clear association between the initial rhythm and 30-day (aRR = 0.88, 95% CI 0.71; 1.11) and 1-year (aRR = 0.85, 95% CI 0.69; 1.04) survival when patient-and cardiac arrest characteristics were adjusted for. Conclusion:In patients with IHCA presenting with PEA or asystole, there were no major differences in patient demographics and comorbidities. The patients differed substantially in cardiac arrest characteristics. Initial PEA was associated with higher risk of ROSC, but there was no difference in 30-day and 1-year survival.

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Section: Introductionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Study Design Setting and Populationmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

“…14 The 180-day time-window was chosen to ensure that prescriptions were indicative of active medications only. 6 A complete list of ATC-codes is provided in the Supplement (Table S1).…”

Section: Data Sourcesmentioning

confidence: 99%

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Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes

et al. 2021

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Clinical characteristics, causes and predictors of outcomes in patients with in-hospital cardiac arrest: results from the SURVIVE-ARREST study

et al. 2022

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Introduction In-hospital cardiac arrest (IHCA) is acutely life-threatening and remains associated with high mortality and morbidity. Identifying predictors of mortality after IHCA would help to guide acute therapy. Methods We determined patient characteristics and independent predictors of 30-day in-hospital mortality, neurological outcome, and discharge/referral pathways in patients experiencing IHCA in a large tertiary care hospital between January 2014 and April 2017. Multivariable Cox regression model was fitted to assess predictors of outcomes. Results A total of 368 patients with IHCA were analysed (median age 73 years (interquartile range 65–78), 123 (33.4%) women). Most patients (45.9%) had an initial non-shockable rhythm and shockable rhythms were found in 20.9%; 23.6% of patients suffered from a recurrent episode of cardiac arrest. 172/368 patients died within 30 days (46.7%). Of 196/368 patients discharged alive after IHCA, the majority (72.9%, n = 143) had a good functional neurological outcome (modified Rankin Scale ≤ 3 points). In the multivariable analysis, return of spontaneous circulation without mechanical circulatory support (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.21–0.64), invasive coronary angiography and/or percutaneous intervention (HR 0.56, 95% CI 0.34–0.92), and antibiotic therapy (HR 0.87, 95% CI 0.83–0.92) were associated with a lower risk of 30-day in hospital mortality. Conclusion In the present study, IHCA was survived in ~ 50% in a tertiary care hospital, although only a minority of patients presented with shockable rhythms. The majority of IHCA survivors (~ 70%) had a good neurological outcome. Recovery of spontaneous circulation and presence of treatable acute causes of the arrest are associated with better survival. Graphical abstract Clinical Characteristics, Causes and Predictors of Outcomes in Patients with In-Hospital Cardiac Arrest: Results from the SURVIVE-ARREST Study. Abbreviations: CPR, cardiopulmonary resuscitation; IHCA, In-hospital cardiac arrest; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; SBP, systolic blood pressure.

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Unfavorable Neurological Outcomes with Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis

Mondal,

Dadana,

Parmar

et al. 2024

SN Compr. Clin. Med.

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The duration of cardiopulmonary resuscitation (CPR) affects neurological outcomes. Conclusive data on its decremental effect on neurological outcomes have not been explored before in a quantitative review. PubMed and Google Scholar were searched for relevant studies from 2015 up to May 2023 using relevant keywords. The odds of good neurological outcomes were studied. Binary random effects were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). A leave-one-out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. For outcomes showing moderate to high heterogeneity, subgroup analysis was performed for follow-up duration or type of study. A p value of < 0.05 was considered statistically significant. A total of 349,027 cardiac arrest patients (mean age, 70.2 years; males, 56.6%) from four studies were included in the meta-analysis. Of them, the initial rhythm was shockable in 11% (38,465/349,027) and non-shockable in 88.97% (310,562/349,027) of the population. Odds of having favorable neurological outcomes were 0.32 (95% CI 0.10–1.01, p = 0.05) for 6–10 min (n = 14,118), 0.10 (95% CI 0.02–0.64, p = 0.02) for 11–15 min (n = 43,885), 0.05 (95% CI 0.01–0.36, p 0.01) for 16–20 min (n = 66,174), 0.04 (95% CI 0.01–0.21, p < 0.01) for > 20 min (n = 181,262), and 0.03 (95% CI 0.00–1.55, p = 0.08) for > 30 min (n = 66,461) when compared to patients receiving CPR for < 5 min (n = 6420). Steady decremental odds of favorable neurological outcomes were seen with every 5 min of increased CPR duration, with a statistically significant decline seen in CPR duration from 11 to 15 min onwards.

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Factors associated with shockable versus non-shockable rhythms in patients with in-hospital cardiac arrest

Cited by 30 publications

References 39 publications

Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes

Pulseless electrical activity vs. asystole in adult in-hospital cardiac arrest: Predictors and outcomes

Clinical characteristics, causes and predictors of outcomes in patients with in-hospital cardiac arrest: results from the SURVIVE-ARREST study

Unfavorable Neurological Outcomes with Incremental Cardiopulmonary Resuscitation Duration in Cardiac Arrest Brain Injury: A Systematic Review and Meta-Analysis

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