Associated Factors of Cardiopulmonary Resuscitation Outcomes; a Cohort Study on an Adult In-hospital Cardiac Arrest Registry
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 Dey 2024
,
Page e30
https://doi.org/10.22037/aaem.v12i1.2227
Abstract
Introduction: In-hospital cardiac arrest (IHCA) remains a substantial cause of morbidity and mortality for hospitalized patients worldwide. This study aimed to identify associated factors of return of spontaneous circulation (ROSC) and survival with favorable neurological outcomes of IHCA patients.
Method: A two-year retrospective cohort study was conducted at a university-based tertiary care hospital in Bangkok, Thailand, studying adult patients aged ≥ 18 years with IHCA from January 2021 to December 2022. The primary endpoint was sustained ROSC, and the secondary endpoint was survival with favorable neurological outcomes defined as Cerebral Performance Categories (CPC) Scale of 1 or 2 at discharge. Pre-arrest and intra-arrest variables were collected and analyzed using multivariable logistic regression to identify independent factors associated with the outcomes.
Results: During the study period, 156 patients were included in the study. 105 (67.3%) patients achieved sustained ROSC after the CPR, 28 patients (18.0%) were discharged alive, and 15 patients (9.6%) survived with a favorable neurological outcome at hospital discharge. Overall, sustained ROSC was higher in patients who had IHCA during the day shift (odds ratio (OR): 4.11; 95% confidence interval (CI): 1.05-16.06) and electrocardiogram (ECG) monitoring prior to arrest (OR: 6.38; 95% CI: 1.18-34.54). In contrast, higher adrenaline doses administrated, and increased CPR duration reduced the odds of sustained ROSC (OR: 0.72; 95% CI: 0.54-0.94 and OR: 0.92; 95% CI: 0.85-0.98, respectively). Arrest due to cardiac etiology was associated with increased discharged survival with favorable neurological outcomes (OR: 13.43; 95% CI: 2.00-89.80), while a higher Good Outcome Following Attempted Resuscitation (GO-FAR) score reduced the odds of the secondary outcome (OR: 0.89; 95% CI: 0.81-0.98).
Conclusion:
The sustained ROSC was higher in IHCA during the daytime shift and under prior ECG monitoring. The administration of higher doses of adrenaline and prolonged CPR durations decreased the likelihood of achieving sustained ROSC. Furthermore, patients with cardiac-related causes of cardiac arrest exhibited a higher rate of survival to hospital discharge with favorable neurological outcomes.
- Heart Arrest
- Hospitalization
- Prognosis
- Survival
- Outcomes
- health care
How to Cite
References
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596.
Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2018;132:90-100.
Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, et al. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S580-s604.
Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in Survival after In-Hospital Cardiac Arrest. New England Journal of Medicine. 2012;367(20):1912-20.
Nas J, te Grotenhuis R, Bonnes JL, Furlaneto JM, van Royen N, Smeets JLRM, et al. Meta-Analysis Comparing Cardiac Arrest Outcomes Before and After Resuscitation Guideline Updates. The American Journal of Cardiology. 2020;125(4):618-29.
Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. Jama. 2019;321(12):1200-10.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
Williams B. The National Early Warning Score: from concept to NHS implementation. Clinical Medicine. 2022;22(6):499-505.
Ferreira FL, Bota DP, Bross A, Mélot C, Vincent J-L. Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. Jama. 2001;286(14):1754-8.
Ebell MH, Jang W, Shen Y, Geocadin RG. Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med. 2013;173(20):1872-8.
Alnabelsi T, Annabathula R, Shelton J, Paranzino M, Faulkner SP, Cook M, et al. Predicting in-hospital mortality after an in-hospital cardiac arrest: A multivariate analysis. Resusc Plus. 2020;4:100039.
Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, Jr., et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013;127(14):1538-63.
Ohbe H, Tagami T, Uda K, Matsui H, Yasunaga H. Incidence and outcomes of in-hospital cardiac arrest in Japan 2011–2017: a nationwide inpatient database study. Journal of Intensive Care. 2022;10(1):10.
Hessulf F, Karlsson T, Lundgren P, Aune S, Strömsöe A, Södersved Källestedt ML, et al. Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases. Int J Cardiol. 2018;255:237-42.
Ko BS, Ahn R, Ryoo SM, Ahn S, Sohn CH, Seo DW, et al. Prevalence and outcomes of endotracheal intubation-related cardiac arrest in the ED. Am J Emerg Med. 2015;33(11):1642-5.
Suraseranivongse S, Chawaruechai T, Saengsung P, Komoltri C. Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country. Resuscitation. 2006;71(2):188-93.
Viarasilpa T. Implementation of neurocritical care in Thailand. Front Neurol. 2022;13:990294.
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.
Hannen LEM, Toprak B, Weimann J, Mahmoodi B, Fluschnik N, Schrage B, et al. Clinical characteristics, causes and predictors of outcomes in patients with in-hospital cardiac arrest: results from the SURVIVE-ARREST study. Clin Res Cardiol. 2023;112(2):258-69.
Wang MT, Huang WC, Yen DH, Yeh EH, Wu SY, Liao HH. The Potential Risk Factors for Mortality in Patients After In-Hospital Cardiac Arrest: A Multicenter Study. Front Cardiovasc Med. 2021;8:630102.
Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, et al. Survival From In-Hospital Cardiac Arrest During Nights and Weekends. Jama. 2008;299(7):785-92.
Musy SN, Endrich O, Leichtle AB, Griffiths P, Nakas CT, Simon M. The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. Int J Nurs Stud. 2021;120:103950.
Ganesan S, Magee M, Stone JE, Mulhall MD, Collins A, Howard ME, et al. The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers. Scientific Reports. 2019;9(1):4635.
Boniol M, McCarthy C, Lawani D, Guillot G, McIsaac M, Diallo K. Inequal distribution of nursing personnel: a subnational analysis of the distribution of nurses across 58 countries. Hum Resour Health. 2022;20(1):22.
Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10341):2129-54.
Kunaviktikul W, Wichaikhum O, Nantsupawat A, Nantsupawat R, Chontawan R, Klunklin A, et al. Nurses' extended work hours: Patient, nurse and organizational outcomes. Int Nurs Rev. 2015;62(3):386-93.
Thorén A, Rawshani A, Herlitz J, Engdahl J, Kahan T, Gustafsson L, et al. ECG-monitoring of in-hospital cardiac arrest and factors associated with survival. Resuscitation. 2020;150:130-8.
Yonis H, Andersen MP, Mills EHA, Winkel BG, Wissenberg M, Køber L, et al. Duration of resuscitation and long-term outcome after in-hospital cardiac arrest: A nationwide observational study. Resuscitation. 2022;179:267-73.
Welbourn C, Efstathiou N. How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review. Scand J Trauma Resusc Emerg Med. 2018;26(1):77.
Matsuyama T, Ohta B, Kiyohara K, Kitamura T. Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry). Critical Care. 2022;26(1):120.
Goldberger ZD, Chan PS, Berg RA, Kronick SL, Cooke CR, Lu M, et al. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. Lancet. 2012;380(9852):1473-81.
Thai TN, Ebell MH. Prospective validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for in-hospital cardiac arrest prognosis. Resuscitation. 2019;140:2-8.
Cho YJ, Kim YJ, Kim MY, Shin YJ, Lee J, Choi E, et al. Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in an East Asian population. Resuscitation. 2020;150:36-40.
Wallmuller C, Meron G, Kurkciyan I, Schober A, Stratil P, Sterz F. Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation. 2012;83(10):1206-11.
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