Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region

Radeschi, G; Mina, Andrea; Berta, G.; Fassiola, Andrea; Roasio, Agostino; Urso, Felice; Penso, Roberto; Zummo, Ugo; Berchialla, Paola; Ristagno, Giuseppe; Sandroni, Claudio

doi:10.1016/j.resuscitation.2017.06.020

Cited by 72 publications

(90 citation statements)

References 32 publications

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“…34,39,40 The median admission duration prior to cardiac arrest is 1 to 2 days, with a higher prevalence of respiratory insufficiency as the cause of cardiac arrest with longer duration of preceding hospitalization. 32,36,40 Neurological causes of cardiac arrest are rare in the in-hospital setting. 36,41 …”

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

679

535

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IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

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Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

679

535

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“…In the UK (data analyzed from 2011 to 2013 in 144 hospitals) the VF/PVT caused SCA in 17% of patients, As in 23.6% of patients, and PEA in 49% of patients; the survival rate was 49% for VF/PVT, 8.7% for As, and 11.4% for PEA, and the overall survival was 18.4% [17]. In Italy (data analyzed from 2012 to 2014 in 36 hospitals) VF/PVT was registered in 19% of patients; the overall survival rate was 14.8% [18].…”

Section: In-hospital Cardiac Arrestmentioning

confidence: 97%

Public-Access Defibrillation in Sudden Cardiac Arrest

Линчак¹,

Boytsov²,

Ардашев³

et al. 2019

Cardiac Diseases and Interventions in 21st Century

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Sudden cardiac arrest caused by cardiac and extracardiac pathology is one of the leading causes of death in developed countries. Public-access defibrillation is one of the key techniques for improvement of the pre-hospital and in-hospital resuscitation success and survival rates of resuscitated patients in the case of a sudden cardiac arrest caused by ventricular fibrillation and pulseless ventricular tachycardia. This book chapter will discuss the relation between the type of a sudden cardiac arrest and the survival rate and the "chain of survival" concept and the role of early public-access defibrillation, as well as the function of public-access defibrillation programs and the contribution of automated external defibrillators in pre-hospital and in-hospital resuscitation.

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“…With the improvement of cardiopulmonary resuscitation (CPR), the resuscitation success rate of the in-hospital cardiac arrest (IHCA) patients has been increased. However, after return of spontaneous circulation (ROSC), the survival rate of discharged patients and their neurological prognosis remain unsatisfactory [1,2,3]. A multi-center study in China has shown that only 6.4% of patients with IHCA had good recovery of neurological functions [4].…”

Section: Introductionmentioning

confidence: 99%

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Liu¹,

Jiang²,

Sun³

et al. 2020

Preprint

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Objectives: To develop a cardiac arrest survival post-resuscitation in-hospital (CASPRI) scoring system evaluating the prognosis of neurological function in ROSC patients.Methods: This single-center, retrospective study reviewed the eligible patients admitted to the emergency department of West China Hospital of Sichuan University who received cardiopulmonary resuscitation and restored spontaneous circulation from January 1, 2014 00:00 to December 31, 2017 23:59. Clinical histories, blood test, biochemistry proﬁle, coagulation indexes and other laboratory tests during emergency department visit were collected. The MEWS, sOHCA, APACHE II, and the highest SOFA scores were calculated during the period between emergency room admission and ROSC. The clinical data of ROSC patients in the test group were analyzed by univariate and multivariate logistic analysis. The possible risk factors related to the unfavorable prognosis of 90-day neurological function were screened and CASPRI score was constructed. The eﬃcacy of CASPRI score on evaluating the neurological function of ROSC patients was analyzed by ROC curve and proved in the validation group.Main results: 503 patients were included in the test group. After correcting potential confounding factors, multivariate logistic regression analysis showed that TBIL, ALB at admission of emergency department, Lac at ROSC, resuscitation time, non-shockable rhythms were independent risk factors for poor neurological prognosis of ROSC patients (p<0.05). ROC curve showed that the CASPRI score was superior to the APACHE II score, SOFA score, MEWS score and sOHCA score, and the diﬀerence was statistically signiﬁcant (p<0.05). In the validation group with 256 patients included, the incidence of poor neurological prognosis in high-risk, intermediate-risk, and low-risk groups based on CASPRI score were 97.89%, 85.59%, and 58.33%, respectively, and the diﬀerence was statistically signiﬁcant (p<0.001). CASPRI score was superior to the SOFA score and MEWS score, the diﬀerence was statistically signiﬁcant (p<0.05).Conclusions: CASPRI score is an eﬀective tool for the early evaluation of the neurological prognosis of ROSC patients. Its eﬃcacy exceeds the MEWS and SOFA scoring systems currently used in clinical practice.

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Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region

Cited by 72 publications

References 32 publications

In-Hospital Cardiac Arrest

In-Hospital Cardiac Arrest

Public-Access Defibrillation in Sudden Cardiac Arrest

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

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