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Circadian variation of in-hospital cardiac arrest

Avnish Tripathi1, Saket Girotra2, Lorrel E Brown Toft3

  • 1University of Kentucky College of Medicine, 421 31 W Bypass, Bowling Green, KY 42101, United States.

Resuscitation
|August 28, 2020
PubMed

Insights

In-hospital cardiac arrests occur with nearly equal frequency throughout the day, unlike out-of-hospital events. This finding suggests consistent hospital staffing is crucial for quality resuscitation care, regardless of the time of day.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Circadian Biology

Background:

  • Out-of-hospital cardiac arrests, particularly those from ventricular tachyarrhythmias, show a higher incidence in the morning.
  • The circadian pattern of in-hospital cardiac arrests remains largely unexamined.

Purpose of the Study:

  • To investigate the circadian variation in the incidence of in-hospital cardiac arrest.
  • To analyze temporal patterns of cardiac arrest based on initial rhythm (shockable vs. non-shockable).

Main Methods:

  • Retrospective analysis of 154,038 patients from the Get With The Guidelines-Resuscitation registry (2000-2014).
  • Multivariable hierarchical logistic regression used to assess circadian rhythm over a 24-hour cycle.
  • Stratification of analysis by initial shockable (ventricular fibrillation/tachycardia) versus non-shockable (asystole/pulseless electrical activity) rhythms.

Main Results:

  • Non-shockable rhythms showed a slightly higher proportion during 0400-0759 (17.9%) and 0000-0359 (17.1%).
  • Shockable rhythms had a greater proportion during 2000-2359 (17.0%) and 1200-1559 (16.9%).
  • Multivariable analysis indicated a small, statistically significant increased risk for non-shockable arrests during early morning hours, but overall incidence was similar across the day.

Conclusions:

  • In-hospital cardiac arrests, regardless of initial rhythm, occur with nearly uniform frequency throughout a 24-hour period.
  • While minor temporal variations exist, the overall circadian pattern is less pronounced than in out-of-hospital arrests.
  • Findings support the need for consistent hospital staffing to ensure uniform resuscitation care quality at all times.
Abstract

Keywords:
AsystoleCircadian variationIn-hospital cardiac arrestPulseless electrical activityVentricular fibrillationVentricular tachycardia

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