Updating the model for Risk-Standardizing survival for In-Hospital cardiac arrest to facilitate hospital comparisons

Chan, Paul S.; Kennedy, Kevin F.; Girotra, Saket

doi:10.1016/j.resuscitation.2022.109686

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…24 Although participation in a cardiac arrest registry can help catalyze quality improvement efforts through benchmarking, there are relatively few national or regional IHCA registries. 25 Exceptions include the American Heart Association Get With The Guidelines-Resuscitation registry, 26 the National Cardiac Arrest Audit in the United Kingdom, 27 and several smaller registries. 1 There is evidence from observational studies that Get With The Guidelines-Resuscitation participation duration is associated with a significant improvement in IHCA quality of care 28 and event survival.…”

Section: Discussionmentioning

confidence: 99%

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes

Nallamothu,

Greif,

Anderson

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Section: Discussionmentioning

confidence: 99%

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes

Nallamothu,

Greif,

Anderson

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…Duration of CPR, treated continuously and truncated at 120 minutes, was the dependent variable. Variables considered for inclusion as fixed effects were primarily based on those associated with cardiac arrest outcomes in previous studies, 12 , 13 , 14 , 15 , 16 , 17 including year, age at the time of event (neonates [≤30 days], infants [31 days to <1 year], young children [1-8 years], and older children [>8 years]), 12 sex, race and ethnicity, event location (pediatric ICU, emergency department, NICU, cardiac ICU, other ICU, operating room or procedural area, newborn area, and other inpatient), time of arrest (day vs night), initial rhythm (ventricular fibrillation, pulseless ventricular tachycardia, asystole, PEA, or bradycardia with poor perfusion), illness category (medical cardiac, medical noncardiac, surgical cardiac, surgical noncardiac, trauma, or newborn), application of an automated external defibrillator, and use of a hospital-wide response. In addition, the following conditions coded as present prior to cardiac arrest were evaluated for the model: congestive heart failure; kidney, hepatic, or respiratory insufficiency; baseline neurologic deficits (measured using the admission PCPC); acute stroke; acute nonstroke neurologic event; pneumonia; hypotension; arrhythmia; sepsis; major trauma; metabolic or electrolyte abnormality; and metastatic or hematologic malignant neoplasm.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of Pediatric In-Hospital Cardiac Arrests and Resuscitation Duration

O’Halloran,

Morgan,

Kennedy

et al. 2024

JAMA Netw Open

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ImportanceCardiopulmonary resuscitation (CPR) duration is associated with cardiac arrest survival.ObjectivesTo describe characteristics associated with CPR duration among hospitalized children without return of circulation (ROC) (patient-level analysis) and determine whether hospital median CPR duration in patients without ROC is associated with survival (hospital-level analysis).Design, Setting, and ParticipantsThis retrospective cohort study of patients undergoing pediatric in-hospital CPR between January 1, 2000, and December 31, 2021, used data from the Get With the Guidelines–Resuscitation registry. Children receiving chest compressions for at least 2 minutes and/or defibrillation were included in the patient-level analysis. For the hospital-level analysis, sites with at least 20 total events and at least 5 events without ROC were included. Data were analyzed from December 1, 2022, to November 15, 2023.ExposuresFor the patient-level analysis, the exposure was CPR duration in patients without ROC. For the hospital-level analysis, the exposure was quartile of median CPR duration in events without ROC at each hospital.Main Outcomes and MeasuresFor the patient-level analysis, outcomes were patient and event factors, including race and ethnicity and event location; we used a multivariable hierarchical linear regression model to assess factors associated with CPR duration in patients without ROC. For the hospital-level analysis, the main outcome was survival to discharge among all site events; we used a random intercept multivariable hierarchical logistic regression model to examine the association between hospital quartile of CPR duration and survival to discharge.ResultsOf 13 899 events, 3859 patients did not have ROC (median age, 7 months [IQR, 0 months to 7 years]; 2175 boys [56%]). Among event nonsurvivors, median CPR duration was longer in those with initial rhythms of bradycardia with poor perfusion (8.37 [95% CI, 5.70-11.03] minutes; P &lt; .001), pulseless electrical activity (8.22 [95% CI, 5.44-11.00] minutes; P &lt; .001), and pulseless ventricular tachycardia (6.17 [95% CI, 0.09-12.26] minutes; P = .047) (vs asystole). Shorter median CPR duration was associated with neonates compared with older children (−4.86 [95% CI, −8.88 to −0.84] minutes; P = .02), emergency department compared with pediatric intensive car7 e unit location (−4.02 [95% CI, −7.48 to −0.57] minutes; P = .02), and members of racial or ethnic minority groups compared with White patients (−3.67 [95% CI, −6.18 to −1.17]; P = .004). Among all CPR events, the adjusted odds of survival to discharge differed based on hospital quartile of median CPR duration among events without ROC; compared with quartile 1 (15.0-25.9 minutes), the adjusted odds ratio for quartile 2 (26.0-29.4 minutes) was 1.22 (95% CI, 1.09-1.36; P &lt; .001); for quartile 3 (29.5-32.9 minutes), 1.23 (95% CI, 1.08-1.39; P = .002); and for quartile 4 (33.0-53.0 minutes), 1.04 (95% CI, 0.91-1.19; P = .58).Conclusions and RelevanceIn this retrospective cohort study of pediatric in-hospital CPR, several factors, including age and event location, were associated with CPR duration in event nonsurvivors. The odds of survival to discharge were lower for patients at hospitals with the shortest and longest median CPR durations among events without ROC. Further studies are needed to determine the optimal duration of CPR during pediatric in-hospital cardiac arrest and to provide training guidelines for resuscitation teams to eliminate disparities in resuscitation care.

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“…The most recent AHA GWTG validated model for risk-standardizing survival for IHCA to enable benchmarking and comparisons now includes COVID-19 infection status a predictor of survival to discharge together with age, initial cardiac arrest rhythm, hospital location, hypotension, sepsis, metastatic/haematological malignancy, renal insufficiency, hepatic insufficiency, metabolic/electrolyte abnormality, major trauma, mechanical ventilation and vasopressor support [20].…”

Section: Impact Of Coronavirus Disease 2019 On In-hospital Cardiac Ar...mentioning

confidence: 99%

In-hospital cardiac arrest

Soar

2023

Current Opinion in Critical Care

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Purpose of reviewTo describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.Recent findingsImproving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are disparities in care based on patient sex, ethnicity and socioeconomic status that need to be tackled. The increased use of emergency treatment plans that include do-not attempt cardiopulmonary resuscitation recommendations will help to decrease the number of resuscitation attempts. System approaches and strong local leadership through resuscitation champions can improve patient outcomes.SummaryIn-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.

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Updating the model for Risk-Standardizing survival for In-Hospital cardiac arrest to facilitate hospital comparisons

Cited by 6 publications

References 26 publications

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes

Characteristics of Pediatric In-Hospital Cardiac Arrests and Resuscitation Duration

In-hospital cardiac arrest

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