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Outcomes of in-hospital cardiac arrest managed with and without a specialized code team: A retrospective
Yasmeen Abu Fraiha1, Tali Shafat2, Shlomi Codish3
1Department of Internal Medicine B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Insights
A dedicated hospital CPR team did not significantly improve survival for in-hospital cardiac arrest (IHCA) patients compared to ward staff. While crude survival was higher with the CPR team, this difference became insignificant after analysis, indicating no clear benefit.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- In-hospital cardiac arrest (IHCA) remains a critical challenge with poor patient outcomes.
- High-quality cardiopulmonary resuscitation (CPR) and effective teamwork are vital for improving survival rates.
- Current guidelines lack clarity on optimal hospital CPR team composition.
Purpose of the Study:
- To compare the effectiveness of a dedicated hospital CPR team versus standard ward medical staff in managing IHCA.
- To evaluate the impact of team composition on patient survival and neurological outcomes following IHCA.
Main Methods:
- A retrospective observational study analyzed IHCA events from January 2016 to December 2019.
- Data were sourced from the Soroka University Medical Center's CPR database.
- Outcomes were compared between patients treated by regular ward staff (ACLS-certified) and a dedicated hospital CPR team.
Main Results:
- Overall survival to discharge was 5% (18/360 patients).
- Crude survival to discharge was higher in the CPR team group (7.6%) compared to the ward team group (1.9%) (p=0.013).
- After propensity score analysis, the difference in survival between the two groups was not statistically significant (p=0.40).
Conclusions:
- No significant difference in survival was observed between IHCA patients treated by a dedicated CPR team versus a standard ward team, despite both receiving advanced cardiac life support (ACLS) training.
- While crude survival-to-discharge rates favored the dedicated CPR team, this finding was not sustained after statistical adjustment.
- Further research may be needed to determine the optimal structure and impact of hospital-based CPR teams.
Background:
In-hospital cardiac arrest (IHCA) still has a poor prognosis despite medical advancements in recent decades. Early and high-quality cardiopulmonary resuscitation (CPR), as well as good teamwork, are important prognostic factors. There are no clear guidelines regarding the composition of a dedicated hospital CPR team. We compared outcomes of IHCA treated by a dedicated hospital CPR team compared to ward medical staff with advanced cardiac life support (ACLS) training.
Methods:
A single-center retrospective observational study based on the cardiopulmonary resuscitation database of Soroka University Medical Center from January 2016 until December 2019. We compared the results of resuscitations conducted by regular ward medical staff, certified in ACLS, versus those conducted by the dedicated hospital's CPR team.
Results:
Of the 360 CPR events analyzed, 141 (39.1%) ended in return of spontaneous circulation, 70 (19.4%) patients were alive after 24 hours, 23 (6.4%) survived for 30 days, and 18 (5%) survived to discharge. Of those who survived to discharge, 11 (61.1%) had a cerebral performance category (CPC) score of 1-2, and 7 (38.9%) had a score of 3-4 (mean 2.09). Survival-to-discharge was significantly higher in the CPR-team group compared to the ward-team group (7.6% vs. 1.9%, p = 0.013). However, with propensity score analysis the difference in survival became insignificant (RR = 1.97, 95% CI: 0.40-9.63, p = 0.40).
Conclusion:
We found no difference in survival between IHCA treated by a dedicated hospital CPR team compared to a standard ward team, both trained with biennial ACLS training. Nevertheless, crude survival-to-discharge was significantly higher in the CPR-team group.
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