The incidence of cardiac arrest in the intensive care unit: A systematic review and meta-analysis

Armstrong, Richard A.; Kane, Caroline M.; Oglesby, Fiona; Barnard, Katie; Soar, Jasmeet; Thomas, Matt

doi:10.1177/1751143718774713

Cited by 26 publications

(33 citation statements)

References 28 publications

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“…Due to clinically important differences, ICU-CA should be considered separately from IHCA in a general ward [14]. The incidence of ICU-CA varies greatly in the literature (4-78/1000 admissions) [14,15]. Survival rates to discharge after ICU-CA are diverse and range from 2 to 79%, mainly depending on the ICU population studied [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

Roedl

Söffker

Wichmann

et al. 2021

JCM

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The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients with COVID-19 treated at the intensive care unit (ICU). The aim was to investigate the incidence and outcome of intensive care unit cardiac arrest (ICU-CA) in critically ill patients with COVID-19. This was a retrospective analysis of prospectively recorded data of all consecutive adult patients with COVID-19 admitted (27 February 2020–14 January 2021) at the University Medical Centre Hamburg-Eppendorf (Germany). Of 183 critically ill patients with COVID-19, 18% (n = 33) had ICU-CA. The median age of the study population was 63 (55–73) years and 66% (n = 120) were male. Demographic characteristics and comorbidities did not differ significantly between patients with and without ICU-CA. Simplified Acute Physiological Score II (SAPS II) (ICU-CA: median 44 points vs. no ICU-CA: 39 points) and Sequential Organ Failure Assessment (SOFA) score (median 12 points vs. 7 points) on admission were significantly higher in patients with ICU-CA. Acute respiratory distress syndrome (ARDS) was present in 91% (n = 30) with and in 63% (n = 94) without ICU-CA (p = 0.002). Mechanical ventilation was more common in patients with ICU-CA (97% vs. 67%). The median stay in ICU before CA was 6 (1–17) days. A total of 33% (n = 11) of ICU-CAs occurred during the first 24 h of ICU stay. The initial rhythm was non-shockable (pulseless electrical activity (PEA)/asystole) in 91% (n = 30); 94% (n = 31) had sustained return of spontaneous circulation (ROSC). The median time to ROSC was 3 (1–5) minutes. Patients with ICU-CA had significantly higher ICU mortality (61% vs. 37%). Multivariable logistic regression showed that the presence of ARDS (odds ratio (OR) 4.268, 95% confidence interval (CI) 1.211–15.036; p = 0.024) and high SAPS II (OR 1.031, 95% CI 0.997–1.065; p = 0.077) were independently associated with the occurrence of ICU-CA. A total of 18% of critically ill patients with COVID-19 suffered from a cardiac arrest within the intensive care unit. The occurrence of ICU-CA was associated with presence of ARDS and severity of illness.

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Section: Introductionmentioning

confidence: 99%

“…The incidence of ICU-CA varies greatly in the literature (4-78/1000 admissions) [14,15]. Survival rates to discharge after ICU-CA are diverse and range from 2 to 79%, mainly depending on the ICU population studied [14,15]. However, one recent study in critically ill patients with COVID-19 reported a mortality rate of 88% [11].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

Roedl

Söffker

Wichmann

et al. 2021

JCM

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“…In-hospital pediatric cardiac arrest occurs in 2-6% of pediatric intensive care admissions (8)(9)(10). Despite the signi cant improvement in resuscitation science and practice over the last two decades (11), cardiac arrests had a signi cant impact on hospital resources and a signi cantly high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes of In-Hospital Cardiac Arrest in Pediatric Patients in the United States

Hamzah¹,

Othman²,

Al‐Subu³

et al. 2021

Preprint

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We report on in-hospital cardiac arrest outcomes in the United States. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000–2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. Non- survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06–1.33, aOR=2.65, CI: 2.37–2.97 and aOR=1.17, CI: 1.07–1.27, respectively). Acute renal failure was associated with decrease in survival (aOR=0.66, CI: 0.60–0.73). There was no difference in mortality between patients with Extracorporeal CardioPulmonary Resuscitation (E-CPR) and those with conventional CardioPulmonary Resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%). In conclusion, we highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest.

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“…To illustrate, consider the United Kingdom's in-hospital mortality rates, which are around 23% in ICU settings [3] and 4% in secondary wards [21]. Similarly, cardiac arrest incidence is estimated to be 2.3% of ICU admissions [2]. Nevertheless, most current adversity-prediction models are benchmarked using the Area Under the Curve (ROC-AUC) [1], [10], [29], [39], [60], which is known to overestimate model performance on minority outcomes under imbalanced distributions [17], [53].…”

Section: Introductionmentioning

confidence: 99%

A Knowledge Distillation Ensemble Framework for Predicting Short- and Long-Term Hospitalization Outcomes From Electronic Health Records Data

Ibrahim

Bean

Searle

et al. 2022

IEEE J. Biomed. Health Inform.

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The ability to perform accurate prognosis is crucial for proactive clinical decision making, informed resource management and personalised care. Existing outcome prediction models suffer from a low recall of infrequent positive outcomes. We present a highly-scalable and robust machine learning framework to automatically predict adversity represented by mortality and ICU admission and readmission from time-series of vital signs and laboratory results obtained within the first 24 hours of hospital admission. The stacked ensemble platform comprises two components: a) an unsupervised LSTM Autoencoder that learns an optimal representation of the time-series, using it to differentiate the less frequent patterns which conclude with an adverse event from the majority patterns that do not, and b) a gradient boosting model, which relies on the constructed representation to refine prediction by incorporating static features. The model is used to assess a patient's risk of adversity and provides visual justifications of its prediction. Results of three case studies show that the model outperforms existing platforms in ICU and general ward settings, achieving average Precision-Recall Areas Under the Curve (PR-AUCs) of 0.891 (95% CI: 0.878 -0.939) for mortality and 0.908 (95% CI: 0.870-0.935) in predicting ICU admission and readmission.

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The incidence of cardiac arrest in the intensive care unit: A systematic review and meta-analysis

Cited by 26 publications

References 28 publications

Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

Survival Outcomes of In-Hospital Cardiac Arrest in Pediatric Patients in the United States

A Knowledge Distillation Ensemble Framework for Predicting Short- and Long-Term Hospitalization Outcomes From Electronic Health Records Data

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