DESIGN: Review. OBJECTIVE: Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. RESULTS AND CONCLUSIONS: The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
DESIGN: Review. OBJECTIVE: Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. RESULTS AND CONCLUSIONS: The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated.
Authors: Vinay M Nadkarni; Gregory Luke Larkin; Mary Ann Peberdy; Scott M Carey; William Kaye; Mary E Mancini; Graham Nichol; Tanya Lane-Truitt; Jerry Potts; Joseph P Ornato; Robert A Berg Journal: JAMA Date: 2006-01-04 Impact factor: 56.272
Authors: Timothy J Hodgetts; Gary Kenward; Ioannis Vlackonikolis; Susan Payne; Nicolas Castle; Robert Crouch; Neil Ineson; Loua Shaikh Journal: Resuscitation Date: 2002-08 Impact factor: 5.262
Authors: Matthew M Churpek; Trevor C Yuen; Michael T Huber; Seo Young Park; Jesse B Hall; Dana P Edelson Journal: Chest Date: 2011-11-03 Impact factor: 9.410
Authors: N I Martinez-Schlurmann; S Rampa; D G Speicher; V Allareddy; A T Rotta; V Allareddy Journal: Bone Marrow Transplant Date: 2015-09-14 Impact factor: 5.483
Authors: Brendan G Carr; Munish Goyal; Roger A Band; David F Gaieski; Benjamin S Abella; Raina M Merchant; Charles C Branas; Lance B Becker; Robert W Neumar Journal: Intensive Care Med Date: 2008-10-21 Impact factor: 17.440
Authors: L Cabrini; G Monti; G Landoni; P Silvani; S Colombo; S Morero; M Mucci; P C Bergonzi; D Mamo; A Zangrillo Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2009
Authors: David G Beiser; Gordon E Carr; Dana P Edelson; Mary Ann Peberdy; Terry L Vanden Hoek Journal: Resuscitation Date: 2009-03-18 Impact factor: 5.262