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Etiologies of In-hospital cardiac arrest: A systematic review and meta-analysis

Joseph Allencherril1, Paul Yong Kyu Lee2, Khurrum Khan3

  • 1Texas Heart Institute, Houston, TX, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.

Resuscitation
|March 12, 2022
PubMed

Insights

In-hospital cardiac arrest (IHCA) is most commonly caused by hypoxia, acute coronary syndrome (ACS), and hypovolemia. Many IHCA causes, like infection and heart failure, differ from typical out-of-hospital arrest (OHCA) etiologies.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • In-hospital cardiac arrest (IHCA) etiologies may differ from out-of-hospital cardiac arrest (OHCA) due to distinct patient populations.
  • Understanding IHCA causes is crucial for targeted clinical interventions.

Purpose of the Study:

  • To identify and analyze the primary etiologies of IHCA in general hospital wards.
  • To compare IHCA causes with established cardiac arrest algorithms.

Main Methods:

  • A systematic literature search was conducted across MEDLINE/PubMed, EMBASE, and Google Scholar.
  • Included studies reporting IHCA etiologies were pooled for a random-effects meta-analysis.
  • Data were analyzed using Review Manager 5.4.

Main Results:

  • Hypoxia (26.46%), acute coronary syndrome (ACS) (18.23%), and hypovolemia (14.81%) were the most frequent IHCA causes.
  • Arrhythmias (14.95%), infection (14.36%), and heart failure (12.64%) were also significant contributors.
  • Unshockable rhythms (PEA/asystole) were present in 69.83% of cases, while shockable rhythms (VT/VF) occurred in 21.75%.

Conclusions:

  • Hypoxia, ACS, and hypovolemia are leading causes of IHCA in general wards.
  • Arrhythmia, infection, and heart failure, often not emphasized in standard cardiac arrest protocols, are significant IHCA etiologies.
  • Traditional "H's and T's" causes are less prevalent in IHCA compared to other identified factors.
Abstract

Keywords:
Acute coronary syndromeCardiac arrestHeart failure

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