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Recognizing the causes of in-hospital cardiac arrest--A survival benefit
Daniel Bergum1, Bjørn Olav Haugen2, Trond Nordseth3
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway.
Insights
Recognizing the cause of in-hospital cardiac arrest (IHCA) significantly improves patient survival. Emergency teams utilizing patient records and clinical symptoms achieved better outcomes during cardiopulmonary resuscitation (CPR).
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Cardiology
Background:
- In-hospital cardiac arrest (IHCA) poses a significant challenge in patient care.
- Emergency teams (ET) may not always identify arrest causes during cardiopulmonary resuscitation (CPR).
- Previous studies indicated a 66% cause recognition rate for IHCA.
Purpose of the Study:
- To determine if recognizing the cause of IHCA improves patient survival.
- To quantify the survival benefit associated with cause recognition by the ET.
Main Methods:
- Propensity score matching was used to compare survival between patients whose IHCA causes were recognized versus those whose causes were not.
- Analysis focused on survival to hospital discharge and 1-hour survival post-arrest.
Main Results:
- Overall survival to hospital discharge was 25%.
- Cause recognition by the ET was associated with a 29% increase in 1-hour survival (p<0.01) and a 19% increase in hospital discharge survival.
- Patient records and pre-arrest symptoms were key information sources for cause identification.
Conclusions:
- Recognition of IHCA causes by the ET provides a substantial survival benefit for patients.
- Effective utilization of patient records and clinical symptoms aids in identifying arrest causes.
Background:
The in-hospital emergency team (ET) may or may not recognize the causes of in-hospital cardiac arrest (IHCA) during the provision of cardiopulmonary resuscitation (CPR). In a previous 4.5-year prospective study, this rate of recognition was found to be 66%. The aim of this study was to investigate whether survival improved if the cause of arrest was recognized by the ET.
Methods:
The difference in survival if the causes were recognized versus not recognized was estimated after propensity score matching patients from these two groups.
Results:
Overall survival to hospital discharge was 25%. After propensity score matching, the benefit of recognizing the cause regarding 1-hour survival of the episode was 29% (p<0.01), and 19% regarding hospital discharge, respectively. Variables commonly known to affect the outcome after cardiac arrest were found to be balanced between the two groups. The largest difference was found in patients with non-cardiac causes and non-shockable presenting rhythms. Patient records and pre-arrest clinical symptoms were the information sources most frequently utilized by the ET to establish the causes of arrest.
Conclusions:
Patients suffering an IHCA showed a substantial survival benefit if the causes of arrest were recognized by the ET. Patient records and pre-arrest clinical symptoms were the sources of information most frequently utilized in these instances.
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