Short and long-term survival following an in-hospital cardiac arrest in a regional hospital cohort

Abstract

Introduction: Evidence about the immediate survival from in-hospital cardiac arrest (IHCA) is well established, however, beyond discharge there is very little describing the long-term outcomes of these patients. Of the few existing studies, all have been conducted in metropolitan centres. Therefore, this study describes survival from IHCA in both the short and long-term in a large regional hospital cohort. Method: A retrospective cohort study was conducted including all adult patients who suffered an IHCA between 1 February 2000 and 31 December 2017 in a large regional (non-metropolitan) hospital in Victoria, Australia. Characteristics of the arrest and patient were sourced from a prospectively collected database that captures all of the arrests occurring in the hospital. Mortality data after discharge were sourced from the state death registry, censored on 31 January 2018. Results: A total of 629 patients were included in the study. Of these, 357 (57%) survived the event, and 213 (34%) survived to discharge. At one-year post-arrest 27% of the original cohort were still alive. The age of the patient, arrest rhythm, location and duration of resuscitation were all significantly associated with long-term survival. Conclusion: Both short and long-term survival following an IHCA in a regional hospital are similar to previously described rates in metropolitan hospitals. Further research is required on the post-discharge correlates of long-term survival.

In-hospital cardiac arrest in hospitals with mature rapid response systems — a multicentre, retrospective cohort study

“…Data are presented as percentages with counts or as medians with interquartile ranges. First, factors previously reported to be associated with IHCA outcome, [2][3][4][5]7,9 as well as all factors judged clinically relevant by the study group, were presented to a univariate model. Univariate logistic regression was used to identify factors plausibly associated with good neurological outcome at hospital discharge with an initial p-value of <0.20.…”

“…6 While the acuity and morbidity of hospitalized patients have increased substantially as a result of expanding treatment possibilities in recent decades, the incidence of IHCA seems to have remained stable or even declined. 3,7 The international adaptation of rapid response systems (RRSs) into hospitals' standard operating procedures may in part explain this trend. 8 Many IHCAs today occur…”

Re: Patient specific advice for in‐hospital cardiac arrest survival rates

“…We are hopeful that any readers of our letter would refer to the original paper published in Resuscitation to consider how applicable these data are for their own patients. 4 While classifying patient populations based on arrest location or rhythm does provide insightful data (as analysed in the original paper), we chose not to present this information in our letter as neither of these variables are known prior to the arrest occurring. The primary purpose of the letter was to provide clinicians with survival data based on known patient factors prior to any arrest.…”

“…2,3 In an earlier publication commenting on the same data, the authors acknowledge that their shortterm survival statistics are better than that of national registries based in the United States and the United Kingdom, and attribute this to the location of care delivery, namely regional versus metropolitan care centers. 4 However, these differences likely go beyond the location of care. Importantly, the authors state that while they did not have access to specific characteristics such as whether the arrest was witnessed or if the patients were in a monitored setting, approximately 40% of arrests occurred in the ED.…”

Patient specific advice for in‐hospital cardiac arrest survival rates

“…The methodology of this study has been previously described, with a total of 629 arrests meeting inclusion criteria. 4 This study was approved by the Human Research Ethics Committees at Monash University (reference number 12353) and Bendigo Health (reference number HREC/17/BHCG/52).…”