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In-hospital cardiac arrest in hospitals with mature rapid response systems - a multicentre, retrospective cohort
Joonas Tirkkonen1, Markus B Skrifvars2, Michael Parr3
1Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland. PO Box 2000, FI-33521 Tampere, Finland; Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia.
Insights
In hospitals with rapid response teams (RRTs), most in-hospital cardiac arrests (IHCAs) occur in independent patients with few comorbidities. Early intervention and monitoring are key to improving outcomes for IHCA patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hospital Medicine
Background:
- In-hospital cardiac arrests (IHCAs) are critical events impacting patient outcomes.
- Mature rapid response systems (RRTs) aim to mitigate adverse events in hospitals.
- Understanding factors influencing IHCA outcomes is crucial for improving care.
Purpose of the Study:
- To investigate IHCAs using the Ustein template in hospitals with established RRTs.
- To identify preceding RRT factors and predictors of favorable neurological outcome (CPC 1-2) post-discharge.
Main Methods:
- Multicenter, retrospective cohort study (2017-2018).
- Inclusion of three tertiary university-affiliated hospitals (two Finnish, one Australian).
- Analysis of 309 IHCAs based on Ustein criteria.
Main Results:
- IHCA incidence was 0.78 per 1000 admissions; median patient age 72, 63% male, 73% previously independent.
- 16% of patients had prior RRT review; 26% met RRT criteria within 8 hours pre-arrest.
- Return of spontaneous circulation in 53%; 28% discharged with CPC 1-2. Younger age, no pre-arrest RRT criteria, arrest during work hours, witnessed arrest, and shockable rhythm predicted favorable outcomes.
Conclusions:
- Hospitals with mature RRTs have low IHCA incidence, with patients often independent and having low comorbidity burden.
- A significant proportion of IHCAs are preceded by clinical deterioration, suggesting a need for enhanced monitoring and earlier interventions.
- Outcomes for IHCA patients in these settings may be better than previously thought, with potential for further improvement.
Aim:
To investigate in-hospital cardiac arrests (IHCAs) according to the Ustein template in hospitals with mature systems utilizing rapid response teams (RRTs), with a special reference to preceding RRT factors and factors associated with a favourable neurological outcome (cerebral performance category (CPC) 1-2) at hospital discharge.
Methods:
Multicentre, retrospective cohort study between 2017-2018 including two Finnish and one Australian university affiliated tertiary hospitals.
Results:
A total 309 IHCAs occurred with an incidence of 0.78 arrests per 1000 hospital admissions. The median age of the patients was 72 years, 63% were male and 73% had previously lived a fully independent life with a median Charlson comorbidity index of two. Before the IHCA, 16% of the patients had been reviewed by RRTs and 26% of the patients fulfilled RRT activation criteria in the preceding 8 h of the IHCA. Return of spontaneous circulation was achieved in 53% of the patients and 28% were discharged from hospital with CPC 1-2. In a multivariable model, younger age, no pre-arrest RRT criteria, arrest in normal work hours, witnessed arrest and shockable initial rhythm were independently associated with CPC 1-2 at hospital discharge.
Conclusions:
In hospitals with mature rapid response systems most IHCA patients live a fully independent life with low burden of comorbid diseases before their hospital admission, the IHCA incidence is low and outcome better than traditionally believed. Deterioration before IHCA is present in a significant number of patients and improved monitoring and earlier interventions may further improve outcomes.
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