1
|
Andrea L, Herman NS, Vine J, Berg KM, Choudhury S, Vaena M, Nogle JE, Halablab SM, Kaviyarasu A, Elmer J, Wardi G, Pearce AK, Crowley C, Long MT, Herbert JT, Shipley K, Bissell Turpin BD, Lanspa MJ, Green A, Ghamande SA, Khan A, Dugar S, Joffe AM, Baram M, March C, Johnson NJ, Reyes A, Denchev K, Loewe M, Moskowitz A. The Discover In-Hospital Cardiac Arrest (Discover IHCA) Study: An Investigation of Hospital Practices After In-Hospital Cardiac Arrest. Crit Care Explor 2024; 6:e1149. [PMID: 39258957 PMCID: PMC11392493 DOI: 10.1097/cce.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
IMPORTANCE In-hospital cardiac arrest (IHCA) is a significant public health burden. Rates of return of spontaneous circulation (ROSC) have been improving, but the best way to care for patients after the initial resuscitation remains poorly understood, and improvements in survival to discharge are stagnant. Existing North American cardiac arrest databases lack comprehensive data on the post-resuscitation period, and we do not know current post-IHCA practice patterns. To address this gap, we developed the Discover In-Hospital Cardiac Arrest (Discover IHCA) study, which will thoroughly evaluate current post-IHCA care practices across a diverse cohort. OBJECTIVES Our study collects granular data on post-IHCA treatment practices, focusing on temperature control and prognostication, with the objective of describing variation in current post-IHCA practice. DESIGN, SETTING, AND PARTICIPANTS This is a multicenter, prospectively collected, observational cohort study of patients who have suffered IHCA and have been successfully resuscitated (achieved ROSC). There are 24 enrolling hospital systems (23 in the United States) with 69 individual enrolling hospitals (39 in the United States). We developed a standardized data dictionary, and data collection began in October 2023, with a projected 1000 total enrollments. Discover IHCA is endorsed by the Society of Critical Care Medicine. INTERVENTIONS, OUTCOMES, AND ANALYSIS The study collects data on patient characteristics including pre-arrest frailty, arrest characteristics, and detailed information on post-arrest practices and outcomes. Data collection on post-IHCA practice was structured around current American Heart Association and European Resuscitation Council guidelines. Among other data elements, the study captures post-arrest temperature control interventions and post-arrest prognostication methods. Analysis will evaluate variations in practice and their association with mortality and neurologic function. CONCLUSIONS We expect this study, Discover IHCA, to identify variability in practice and outcomes following IHCA, and be a vital resource for future investigations into best-practice for managing patients after IHCA.
Collapse
Affiliation(s)
- Luke Andrea
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Nathaniel S. Herman
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| | - Jacob Vine
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Katherine M. Berg
- Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Saiara Choudhury
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Mariana Vaena
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Jordan E. Nogle
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Saleem M. Halablab
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Aarthi Kaviyarasu
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA
| | - Alex K. Pearce
- Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California San Diego, La Jolla, CA
| | - Conor Crowley
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Micah T. Long
- Department of Anesthesiology, Division of Critical Care, University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - J. Taylor Herbert
- Division of Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Kipp Shipley
- Critical Care Outreach Team, Vanderbilt University Medical Center, Nashville, TN
| | - Brittany D. Bissell Turpin
- Department of Pharmacy, University of Kentucky, Lexington, KY
- Department of Pharmacy, Ephraim McDowell Regional Medical Center, Danville, KY
| | - Michael J. Lanspa
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT
| | - Adam Green
- Division of Critical Care, Cooper University Health Care, Camden, NJ
- Cooper Medical School of Rowan University, Camden, NJ
| | - Shekhar A. Ghamande
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Medical Center, Baylor College of Medicine, Temple, TX
| | - Akram Khan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, OR
| | - Siddharth Dugar
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron M. Joffe
- Department of Anesthesiology, Valleywise Health Medical Center, Creighton University School of Medicine, Phoenix, AZ
| | - Michael Baram
- Korman Lung Center, Thomas Jefferson University, Philadelphia, PA
| | - Cooper March
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Nicholas J. Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA
| | | | | | - Michael Loewe
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
- Louisiana State University Health Sciences Center, Emergency Medicine Residency Program, Baton Rouge Campus, Baton Rouge, LA
| | - Ari Moskowitz
- Bronx Center for Critical Care Outcomes and Resuscitation Research, Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
2
|
Treml B, Eckhardt C, Oberleitner C, Ploner T, Rugg C, Radovanovic Spurnic A, Rajsic S. [Quality of life after in-hospital cardiac arrest : An 11-year experience from an university center]. DIE ANAESTHESIOLOGIE 2024; 73:454-461. [PMID: 38819460 PMCID: PMC11222208 DOI: 10.1007/s00101-024-01423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Cardiac arrest is a life-threatening condition requiring urgent medical care and is one of the leading causes of death worldwide. Given that in-hospital cardiac arrest (IHCA) is still poorly investigated, data on health-associated quality of life thereafter remains scarce. The available evidence is mostly transferred from out-of-hospital cardiac arrest studies, but the epidemiology and determinants of success might be different. The aim of the study was to investigate the change in the quality of life after in-hospital cardiac arrest and to identify potential risk factors for a poor outcome. MATERIAL AND METHODS This retrospective analysis of data and prospective evaluation of quality of life included all patients surviving an IHCA and being treated by the emergency medical team between 2010 and 2020. The primary endpoint of the study was the quality of life after IHCA at the reference date. Secondary endpoints covered determination of risk factors and predictors of poor outcome after in-hospital cardiopulmonary resuscitation. RESULTS In total 604 patients were resuscitated within the period of 11 years and 61 (10%) patients survived until the interview took place. Finally, 48 (79%) patients fulfilled the inclusion criteria and 31 (65%) were included in the study. There was no significant difference in the quality of life before and after cardiac arrest (EQ-5D-5L utility 0.79 vs. 0.78, p = 0.567) and in the EQ-5D-5L visual analogue scale (VAS) score. CONCLUSION The quality of life before and after IHCA in survivors was good and comparable. The quality of life was mostly affected by reduced mobility and anxiety/depression. Future studies with larger patient samples should focus on potentially modifiable factors that could prevent, warn, and limit the consequences of in-hospital cardiac arrest. Moreover, research on outcomes of IHCA should include available tools for the quality of life assessment.
Collapse
Affiliation(s)
- Benedikt Treml
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Christine Eckhardt
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Christoph Oberleitner
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Thomas Ploner
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich
| | - Christopher Rugg
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | | | - Sasa Rajsic
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| |
Collapse
|
3
|
Beekman R, Gilmore EJ. Cerebral edema following cardiac arrest: Are all shades of gray equal? Resuscitation 2024; 198:110213. [PMID: 38636600 DOI: 10.1016/j.resuscitation.2024.110213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
4
|
Karpati PC. From Asclepius to medical emergency teams. Minerva Anestesiol 2023; 89:4-6. [PMID: 36745116 DOI: 10.23736/s0375-9393.22.16974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Peter C Karpati
- Weymouth Street Hospital, London, UK - .,London Hyperbaric Unit, Whipps Cross Hospital, Barts Health NHS Trust, London, UK -
| |
Collapse
|
5
|
Chien YS, Tsai MS, Huang CH, Lai CH, Huang WC, Chan L, Kuo LK. Outcomes of Targeted Temperature Management for In-Hospital and Out-Of-Hospital Cardiac Arrest: A Matched Case-Control Study Using the National Database of Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) Registry. Med Sci Monit 2021; 27:e931203. [PMID: 34244465 PMCID: PMC8278959 DOI: 10.12659/msm.931203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to compare outcomes of targeted temperature management (TTM) for patients with in-hospital and out-of-hospital cardiac arrest using the national database of TaIwan network of targeted temperature ManagEment for CARDiac arrest (TIMECARD) registry. MATERIAL AND METHODS A retrospective, matched, case-control study was conducted. Patients with in-hospital cardiac arrest (IHCA) treated with TTM after the return of spontaneous circulation (ROSC) were selected as the case group and controls were defined as the same number of patients with out-of-hospital cardiac arrest (OHCA), matched for sex, age, Charlson comorbidity index, and cerebral performance category. Neurological outcome and survival at hospital discharge were the primary outcome measures. RESULTS Data of 103 patients with IHCA and matched controls with OHCA were analyzed. Patients with IHCA were more likely to experience witnessed arrest and bystander cardiopulmonary resuscitation (CPR). The duration from collapse to the beginning of CPR, CPR time, and the duration from ROSC to initiation of TTM were shorter in the IHCA group but their initial arterial blood pressure after ROSC was lower. Overall, 88% of patients survived to completion of TTM and 43% survived to hospital discharge. Hospital survival (42.7% vs 42.7%, P=1.00) and favorable neurological outcome at discharge (19.4% vs 12.7%, P=0.25) did not differ between the 2 groups. CONCLUSIONS The findings from the national TIMECARD registry showed that clinical outcomes following TTM for patients with IHCA were not significantly different from OHCA when baseline factors were matched.
Collapse
Affiliation(s)
- Yu-San Chien
- Department of Critical Care, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University, Shuang-Ho Hospital, New Taipei, Taiwan
| | - Li-Kuo Kuo
- Department of Critical Care, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| |
Collapse
|
6
|
Roedl K, Kluge S. [Novel aspects on causes of in-hospital cardiac arrest]. Dtsch Med Wochenschr 2021; 146:733-737. [PMID: 34062588 DOI: 10.1055/a-1258-5243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiac arrest is one of the most dramatic medical emergencies. The occurence of cardiac arrest in hospitalized patients, the so called in-hospital cardiac arrest, is common and associated with high mortality. However, in-hospital cardiac arrest has received quite little attention compared to cardiac arrest occuring outside the hospital. The present article reviews the recent literature of in-hospital cardiac arrest and outlines differences in characteristics and outcome compared to out of hospital cardiac arrest. Moreover, current literature regarding occurence and outcome of in-hospital cardiac arrest in hospitalized patients with COVID-19 is concisely summarized.
Collapse
Affiliation(s)
- Kevin Roedl
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
7
|
Szarpak L, Borkowska M, Peacock FW, Rafique Z, Gasecka A, Smereka J, Pytkowska K, Jachowicz M, Iskrzycki L, Gilis-Malinowska N, Jaguszewski MJ. Characteristics and outcomes of in-hospital cardiac arrest in COVID-19. A systematic review and meta-analysis. Cardiol J 2021; 28:503-508. [PMID: 33942278 DOI: 10.5603/cj.a2021.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The purpose herein, was to perform a systematic review of interventional outcome studies in patients with in-hospital cardiac arrest before and during the coronavirus disease 2019 (COVID-19) pandemic period. METHODS A meta-analysis was performed of publications meeting the following PICOS criteria: (1) participants, patients > 18 years of age with cardiac arrest due to any causes; (2) intervention, cardiac arrest in COVID-19 period; (3) comparison, cardiac arrest in pre-COVID-19 period; (4) outcomes, detailed information for survival; (5) study design, randomized controlled trials, quasi-randomized or observational studies comparing cardiac arrest in COVID-19 and pre-COVID-19 period for their effects in patients with cardiac arrest. RESULTS Survival to hospital discharge for the pre-pandemic and pandemic period was reported in 3 studies (n =1432 patients) and was similar in the pre-pandemic vs. the pandemic period, 35.6% vs. 32.1%, respectively (odds ratio [OR] 1.72; 95% confidence interval [CI] 0.81-3.65; p = 0.16; I2 = 72%). Return of spontaneous circulation was reported by all 4 studies and were also similar in the pre and during COVID-19 periods, 51.9% vs. 48.7% (OR 1.27; 95% CI 0.78-2.07; p = 0.33; I2 = 71%), respectively. Pooled analysis of cardiac arrest recurrence was also similar, 24.9% and 17.9% (OR 1.60; 95% CI 0.99-2.57; p = 0.06; I2 = 32%) in the pre and during COVID-19 cohorts. Survival with Cerebral Performance Category 1 or 2 was higher in pre vs. during pandemic groups (27.3 vs. 9.1%; OR 3.75; 95% CI 1.26-11.20; p = 0.02). Finally, overall mortality was similar in the pre vs. pandemic groups, 65.9% and 67.2%, respectively (OR 0.67; 95% CI 0.33-1.34; p = 0.25; I2 = 76%). CONCLUSIONS Compared to the pre-pandemic period, in hospital cardiac arrest in COVID-19 patients was numerically higher but had statistically similar outcomes.
Collapse
Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.,Maria Sklodowska-Curie Białystok Oncology Center, Bialystok, Poland
| | | | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.,Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Katarzyna Pytkowska
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Marta Jachowicz
- Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Lukasz Iskrzycki
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | | | | |
Collapse
|
8
|
Data-driven classification of arrest location for emergency department cardiac arrests. Resuscitation 2020; 154:26-30. [PMID: 32673732 DOI: 10.1016/j.resuscitation.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/14/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Resuscitation research is inconsistent in how emergency department (ED) arrests are classified. We tested whether clinical features of ED arrests more closely resembled out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). METHODS We performed a retrospective study including all patients resuscitated from cardiac arrest at a single academic medical center from January 2010 to December 2019. We abstracted clinical information from our prospective registry. We used unsupervised learning (k-prototypes) to identify clusters within the OHCA and IHCA cohorts. We determined the number of subgroups using scree plots. We assigned individual ED arrest patients the nearest OHCA or IHCA cluster based on the shortest Gower distance from that patient to the nearest cluster center. In our secondary analysis, we determined the optimal number of clusters in each of the 3 arrest cohorts, and then calculated the mean Gower distances with the standard deviation (SD) between cluster centers (ED-IHCA, ED-OHCA, IHCA-OHCA). RESULTS We included 2723 patients: 372 (14%) ED arrests, 1709 (63%) OHCA, and 642 (23%) IHCA. We identified 3 clusters of OHCA patients, and 4 clusters of IHCA patients. Of ED arrest cases, 292 (78%) most closely resembled an IHCA cluster and 80 (22%) most closely resembled an OHCA cluster. Mean (SD) Gower distance between ED arrest and IHCA centers was 0.33 (0.2). Mean Gower distances between ED arrest-OHCA centers and between IHCA-OHCA centers were 0.41 (0.11). CONCLUSION Across multiple aggregated measures, ED arrests resemble IHCA more than OHCA.
Collapse
|
9
|
Stankovic N, Høybye M, Lind PC, Holmberg M, Andersen LW. Socioeconomic status and in-hospital cardiac arrest: A systematic review. Resusc Plus 2020; 3:100016. [PMID: 34223299 PMCID: PMC8244497 DOI: 10.1016/j.resplu.2020.100016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/06/2020] [Accepted: 06/27/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To perform a review of the literature on the association between socioeconomic status and risk of and outcomes after in-hospital cardiac arrest. Data sources PubMed and Embase were searched on January 24, 2020 for studies evaluating the association between socioeconomic status and risk of and/or outcomes after in-hospital cardiac arrest. Two reviewers independently screened the titles/abstracts and selected full texts for relevance. Data were extracted from included studies. Risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. Results The literature search yielded 4960 unique records. We included nine studies evaluating the association between socioeconomic status and risk of and/or outcomes after in-hospital cardiac arrest. All studies were observational cohort studies, of which seven were from the USA. Seven studies were in an adult population, while two studies were in a pediatric population. Results were overall inconsistent although some studies found a higher in-hospital cardiac arrest incidence in patients from low-income communities. There was no clear association between other socioeconomic factors (i.e. education, occupation, marital status, and insurance) and risk of or outcomes after in-hospital cardiac arrest. Due to the scarcity and heterogeneity of available studies, meta-analyses were not performed. Conclusion There are limited data regarding the association between socioeconomic status and risk of and outcomes after in-hospital cardiac arrest and further research is warranted. Understanding the association between socioeconomic status and in-hospital cardiac arrest may reveal strategies to mitigate potential inequalities.
Collapse
Affiliation(s)
- Nikola Stankovic
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Maria Høybye
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Peter Carøe Lind
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Denmark
| | - Lars W. Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Aarhus N, 8200, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, Aarhus N, 8200, Denmark
- Corresponding author. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, Aarhus N, 8200, Denmark.
| |
Collapse
|
10
|
Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Vaillancourt C, Rowan KM, Harrison DA, Nolan JP, Kyeremanteng K, McIsaac DI, Guyatt GH, Perry JJ. Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis. BMJ 2019; 367:l6373. [PMID: 31801749 PMCID: PMC6891802 DOI: 10.1136/bmj.l6373] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database. STUDY SELECTION CRITERIA English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. DATA EXTRACTION PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence. RESULTS The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival. CONCLUSION Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018104795.
Collapse
Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Tran
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| |
Collapse
|
11
|
Witten L, Gardner R, Holmberg MJ, Wiberg S, Moskowitz A, Mehta S, Grossestreuer AV, Yankama T, Donnino MW, Berg KM. Reasons for death in patients successfully resuscitated from out-of-hospital and in-hospital cardiac arrest. Resuscitation 2019; 136:93-99. [PMID: 30710595 DOI: 10.1016/j.resuscitation.2019.01.031] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION There is no standard for categorizing reasons for death in those who achieve return of spontaneous circulation (ROSC) after cardiac arrest but die before hospital discharge. Categorization is important for comparing outcomes across studies, assessing benefits of interventions, and developing quality-improvement initiatives. We developed and tested a method for categorizing reasons for death after cardiac arrest in both in-hospital (IHCA) and out-of-hospital (OHCA) arrests. METHODS Single-center, retrospective, cohort study of patients with ROSC after IHCA or OHCA between 2008 and 2017 who died before hospital discharge. Traumatic arrests and patients with "do-not-resuscitate" orders prior to their arrest were excluded. Two investigators assigned each patient to one of five predefined reasons for death. Interrater reliability was assessed using Fleiss' kappa. For final categorization, discrepancies were resolved by a third investigator. RESULTS There were 182 IHCA and 226 OHCA included. There was substantial agreement between raters (kappa of 0.62 and 0.61 for IHCA and OHCA, respectively). Reasons for death for IHCA and OHCA were: neurological withdrawal of care (27% vs 73%), comorbid withdrawal of care (36% vs 4%), refractory hemodynamic shock (25% vs 17%), respiratory failure (1% vs 3%), and sudden cardiac death (11% vs 4%). The differences in reasons for death among the two groups were significant (p-value < 0.001). CONCLUSIONS Categorizing reasons for death after cardiac arrest with ROSC is feasible using our proposed categories, with substantial inter-rater agreement. Neurologic withdrawal of care is much less common in IHCA than OHCA, which may have implications for further research.
Collapse
Affiliation(s)
- Lise Witten
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ryan Gardner
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mathias J Holmberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Wiberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shivani Mehta
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne V Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tuyen Yankama
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katherine M Berg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| |
Collapse
|
12
|
Holmberg MJ, Geri G, Wiberg S, Guerguerian AM, Donnino MW, Nolan JP, Deakin CD, Andersen LW. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: A systematic review. Resuscitation 2018; 131:91-100. [PMID: 30063963 DOI: 10.1016/j.resuscitation.2018.07.029] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 01/21/2023]
Abstract
AIM To assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual or mechanical cardiopulmonary resuscitation (CPR), for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in adults and children. METHODS The PRISMA guidelines were followed. We searched Medline, Embase, and Evidence-Based Medicine Reviews for randomized clinical trials and observational studies published before May 22, 2018. The population included adult and pediatric patients with OHCA and IHCA of any origin. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the ROBINS-I tool. Outcomes included short-term and long-term survival and favorable neurological outcome. RESULTS We included 25 observational studies, of which 15 studies were in adult OHCA, 7 studies were in adult IHCA, and 3 studies were in pediatric IHCA. There were no studies in pediatric OHCA. No randomized trials were included. Results from individual studies were largely inconsistent, although several studies in adult and pediatric IHCA were in favor of ECPR. The risk of bias for individual studies was overall assessed to be critical, with confounding being the primary source of bias. The overall quality of evidence was assessed to be very low. Heterogeneity across studies precluded any meaningful meta-analyses. CONCLUSIONS There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.
Collapse
Affiliation(s)
- Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, 8200 Aarhus N, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA
| | - Guillaume Geri
- Medical Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Ambroise Paré Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France; Versailles Saint Quentin University, INSERM UMR1018, Team 5 Kidney & Heart, 78000 Versailles, France
| | - Sebastian Wiberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA
| | - Jerry P Nolan
- Bristol Medical School, University of Bristol, 69 St Michael's Hill, Bristol BS2 8DZ, UK
| | - Charles D Deakin
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton, SO16 6YD, UK
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, Bygning J, Plan 1, 8200 Aarhus N, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA.
| | | |
Collapse
|