TY - JOUR
T1 - In-hospital cardiac arrest in hospitals with mature rapid response systems
T2 - a multicentre, retrospective cohort study
AU - Tirkkonen, Joonas
AU - Skrifvars, Markus B.
AU - Parr, Michael M.
AU - Tamminen, Tero
AU - Aneman, Anders
PY - 2020/4/1
Y1 - 2020/4/1
N2 - 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.
AB - 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.
KW - In-hospital cardiac arrest
KW - Rapid response system
KW - Rapid response team
UR - http://www.scopus.com/inward/record.url?scp=85080075922&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2020.02.022
DO - 10.1016/j.resuscitation.2020.02.022
M3 - Article
C2 - 32114070
AN - SCOPUS:85080075922
VL - 149
SP - 109
EP - 116
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -