Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes
BackgroundIn‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable dea...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.003638 |
| _version_ | 1818774928191651840 |
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| author | Sarah M. Perman Emily Stanton Jasmeet Soar Robert A. Berg Michael W. Donnino Mark E. Mikkelsen Dana P. Edelson Matthew M. Churpek Lin Yang Raina M. Merchant |
| author_facet | Sarah M. Perman Emily Stanton Jasmeet Soar Robert A. Berg Michael W. Donnino Mark E. Mikkelsen Dana P. Edelson Matthew M. Churpek Lin Yang Raina M. Merchant |
| author_sort | Sarah M. Perman |
| collection | DOAJ |
| description | BackgroundIn‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. Methods and ResultsThis is a retrospective study of adult IHCA events in the Get with the Guidelines—Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital‐level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed‐days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed‐days in both locations. ConclusionsSurvival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA. |
| first_indexed | 2024-12-18T10:48:56Z |
| format | Article |
| id | doaj.art-c2bdc27c6aa04cc4928cf1b94d96ac8a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:48:56Z |
| publishDate | 2016-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c2bdc27c6aa04cc4928cf1b94d96ac8a2022-12-21T21:10:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-10-0151010.1161/JAHA.116.003638Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and OutcomesSarah M. Perman0Emily Stanton1Jasmeet Soar2Robert A. Berg3Michael W. Donnino4Mark E. Mikkelsen5Dana P. Edelson6Matthew M. Churpek7Lin Yang8Raina M. Merchant9Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CODivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PASouthmead Hospital, North Bristol NHS Trust, Bristol, UKDivision of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PABeth Israel Deaconess Medical Center, Boston, MADivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PADepartment of Internal Medicine, University of Chicago, Chicago, ILDepartment of Internal Medicine, University of Chicago, Chicago, ILPerelman School of Medicine at the University of Pennsylvania, Philadelphia, PADepartment of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PABackgroundIn‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. Methods and ResultsThis is a retrospective study of adult IHCA events in the Get with the Guidelines—Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital‐level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed‐days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed‐days in both locations. ConclusionsSurvival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.https://www.ahajournals.org/doi/10.1161/JAHA.116.003638critical carein‐hospital cardiac arrestoutcomeresuscitation |
| spellingShingle | Sarah M. Perman Emily Stanton Jasmeet Soar Robert A. Berg Michael W. Donnino Mark E. Mikkelsen Dana P. Edelson Matthew M. Churpek Lin Yang Raina M. Merchant Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease critical care in‐hospital cardiac arrest outcome resuscitation |
| title | Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes |
| title_full | Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes |
| title_fullStr | Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes |
| title_full_unstemmed | Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes |
| title_short | Location of In‐Hospital Cardiac Arrest in the United States—Variability in Event Rate and Outcomes |
| title_sort | location of in hospital cardiac arrest in the united states variability in event rate and outcomes |
| topic | critical care in‐hospital cardiac arrest outcome resuscitation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.003638 |
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