Joonas Tirkkonen1, Markus B Skrifvars2, Michael Parr3, Tero Tamminen4, Anders Aneman5. 1. Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland. PO Box 2000, FI-33521 Tampere, Finland; Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia. Electronic address: joonas.tirkkonen@tuni.fi. 2. Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. PO Box 22, FI-00014 Helsinki, Finland. Electronic address: markus.skrifvars@hus.fi. 3. Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia. Electronic address: michael.parr@health.nsw.gov.au. 4. Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital. PO Box 22, FI-00014 Helsinki, Finland. Electronic address: tero.tamminen@hus.fi. 5. Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia; Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, Macquarie University, NSW 2109, Australia. Electronic address: anders.aneman@health.nsw.gov.au.
Abstract
AIM: To investigate in-hospital cardiac arrests (IHCAs) according to the Ustein template in hospitals with mature systems utilizing rapid response teams (RRTs), with a special reference to preceding RRT factors and factors associated with a favourable neurological outcome (cerebral performance category (CPC) 1-2) at hospital discharge. METHODS: Multicentre, retrospective cohort study between 2017-2018 including two Finnish and one Australian university affiliated tertiary hospitals. RESULTS: A total 309 IHCAs occurred with an incidence of 0.78 arrests per 1000 hospital admissions. The median age of the patients was 72 years, 63% were male and 73% had previously lived a fully independent life with a median Charlson comorbidity index of two. Before the IHCA, 16% of the patients had been reviewed by RRTs and 26% of the patients fulfilled RRT activation criteria in the preceding 8 h of the IHCA. Return of spontaneous circulation was achieved in 53% of the patients and 28% were discharged from hospital with CPC 1-2. In a multivariable model, younger age, no pre-arrest RRT criteria, arrest in normal work hours, witnessed arrest and shockable initial rhythm were independently associated with CPC 1-2 at hospital discharge. CONCLUSIONS: In hospitals with mature rapid response systems most IHCA patients live a fully independent life with low burden of comorbid diseases before their hospital admission, the IHCA incidence is low and outcome better than traditionally believed. Deterioration before IHCA is present in a significant number of patients and improved monitoring and earlier interventions may further improve outcomes.
AIM: To investigate in-hospital cardiac arrests (IHCAs) according to the Ustein template in hospitals with mature systems utilizing rapid response teams (RRTs), with a special reference to preceding RRT factors and factors associated with a favourable neurological outcome (cerebral performance category (CPC) 1-2) at hospital discharge. METHODS: Multicentre, retrospective cohort study between 2017-2018 including two Finnish and one Australian university affiliated tertiary hospitals. RESULTS: A total 309 IHCAs occurred with an incidence of 0.78 arrests per 1000 hospital admissions. The median age of the patients was 72 years, 63% were male and 73% had previously lived a fully independent life with a median Charlson comorbidity index of two. Before the IHCA, 16% of the patients had been reviewed by RRTs and 26% of the patients fulfilled RRT activation criteria in the preceding 8 h of the IHCA. Return of spontaneous circulation was achieved in 53% of the patients and 28% were discharged from hospital with CPC 1-2. In a multivariable model, younger age, no pre-arrest RRT criteria, arrest in normal work hours, witnessed arrest and shockable initial rhythm were independently associated with CPC 1-2 at hospital discharge. CONCLUSIONS: In hospitals with mature rapid response systems most IHCA patients live a fully independent life with low burden of comorbid diseases before their hospital admission, the IHCA incidence is low and outcome better than traditionally believed. Deterioration before IHCA is present in a significant number of patients and improved monitoring and earlier interventions may further improve outcomes.
Authors: Myung Jin Song; Dong-Seon Lee; Yun-Young Choi; Da-Yun Lee; Hye-Min Jo; Sung Yoon Lim; Jong Sun Park; Young-Jae Cho; Ho Il Yoon; Jae Ho Lee; Choon-Taek Lee; Yeon Joo Lee Journal: PLoS One Date: 2022-02-25 Impact factor: 3.240
Authors: Sagar S Maddani; Souvik Chaudhuri; H M Krishna; Shwethapriya Rao; Narayanan H Unnithan; Sunil T Ravindranath Journal: Indian J Anaesth Date: 2022-02-24