Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes

American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background-In-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 Results-This 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. Conclusions-Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.

Original languageEnglish (US)
Article numbere003638
JournalJournal of the American Heart Association
Volume5
Issue number10
DOIs
StatePublished - 2016

Fingerprint

Heart Arrest
Intensive Care Units
Telemetry
Inpatients
Survival
Ventricular Fibrillation
Ventricular Tachycardia
Resuscitation
Patient Care
Survival Rate
Retrospective Studies
Public Health
Databases
Guidelines

Keywords

  • Critical care
  • In-hospital cardiac arrest
  • Outcome
  • Resuscitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators (2016). Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes. Journal of the American Heart Association, 5(10), [e003638]. https://doi.org/10.1161/JAHA.116.003638

Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes. / American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators.

In: Journal of the American Heart Association, Vol. 5, No. 10, e003638, 2016.

Research output: Contribution to journalArticle

American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators 2016, 'Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes', Journal of the American Heart Association, vol. 5, no. 10, e003638. https://doi.org/10.1161/JAHA.116.003638
American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes. Journal of the American Heart Association. 2016;5(10). e003638. https://doi.org/10.1161/JAHA.116.003638
American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. / Location of in-hospital cardiac arrest in the united states-variability in event rate and outcomes. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 10.
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abstract = "Background-In-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 Results-This 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. Conclusions-Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.",
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AU - American Heart Association's Get With the Guidelines®-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators

AU - Perman, Sarah M.

AU - Stanton, Emily

AU - Soar, Jasmeet

AU - Berg, Robert A.

AU - Donnino, Michael W.

AU - Mikkelsen, Mark E.

AU - Edelson, Dana P.

AU - Churpek, Matthew M.

AU - Yang, Lin

AU - Merchant, Raina M.

AU - Nichol, Graham

AU - Nadkarni, Vinay M.

AU - Peberdy, Mary Ann

AU - Chan, Paul S.

AU - Mader, Tim

AU - Kern, Karl B

AU - Warren, Sam

AU - Allen, Emilie

AU - Eigel, Brian

AU - Hunt, Elizabeth A.

AU - Ornato, Joseph P.

AU - Braithwaite, Scott

AU - Geocadin, Romergryko G.

AU - Mancini, Mary E.

AU - Potts, Jerry

AU - Truitt, Tanya Lane

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N2 - Background-In-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 Results-This 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. Conclusions-Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.

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KW - Critical care

KW - In-hospital cardiac arrest

KW - Outcome

KW - Resuscitation

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