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Location of In ‐ Hospital Cardiac Arrest in the United States — Variability in Event Rate and Outcomes

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Rate of in‐hospital cardiac arrest/1000 patient bed‐days by location. This figure illustrates the rate of IHCA/1000 patient bed‐days by location per year over the study period. (Data were collected from January 1, 2003 to September 14, 2010, and therefore 2010 is incomplete). IHCA indicates in‐hospital cardiac arrest.
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jah31737-fig-0002: Rate of in‐hospital cardiac arrest/1000 patient bed‐days by location. This figure illustrates the rate of IHCA/1000 patient bed‐days by location per year over the study period. (Data were collected from January 1, 2003 to September 14, 2010, and therefore 2010 is incomplete). IHCA indicates in‐hospital cardiac arrest.

Mentions: The mean event rate of IHCA/1000 patient bed‐days was also higher in the ICU across all years of the study (2003–2010) (Figure 2). The proportion of patients who survived IHCA improved over the 7‐year period and with greater improvement in survival rates observed in the inpatient ward than in the ICU setting (P<0.001) (Figure 3).


Location of In ‐ Hospital Cardiac Arrest in the United States — Variability in Event Rate and Outcomes
Rate of in‐hospital cardiac arrest/1000 patient bed‐days by location. This figure illustrates the rate of IHCA/1000 patient bed‐days by location per year over the study period. (Data were collected from January 1, 2003 to September 14, 2010, and therefore 2010 is incomplete). IHCA indicates in‐hospital cardiac arrest.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121474&req=5

jah31737-fig-0002: Rate of in‐hospital cardiac arrest/1000 patient bed‐days by location. This figure illustrates the rate of IHCA/1000 patient bed‐days by location per year over the study period. (Data were collected from January 1, 2003 to September 14, 2010, and therefore 2010 is incomplete). IHCA indicates in‐hospital cardiac arrest.
Mentions: The mean event rate of IHCA/1000 patient bed‐days was also higher in the ICU across all years of the study (2003–2010) (Figure 2). The proportion of patients who survived IHCA improved over the 7‐year period and with greater improvement in survival rates observed in the inpatient ward than in the ICU setting (P<0.001) (Figure 3).

View Article: PubMed Central - PubMed

ABSTRACT

Background: In&#8208;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&mdash;Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital&#8208;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&nbsp;201 IHCA events at 445 hospitals, 59% (50&nbsp;514) occurred in the ICU compared to 41% (34&nbsp;687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64&plusmn;16&nbsp;years versus 69&plusmn;14; P&lt;0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P&lt;0.001). In the ICU, mean event rate/1000 bed&#8208;days was 0.337 (&plusmn;0.215) compared with 0.109 (&plusmn;0.079) for telemetry wards and 0.134 (&plusmn;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&nbsp;patient bed&#8208;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.

No MeSH data available.


Related in: MedlinePlus