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.
Bibliographical noteFunding Information:
Dr Churpek has a patent pending (ARCD. P0535US.P2) for risk-stratification algorithms for hospitalized patients and research support from the National Institutes of Health (NIH) (K08 HL121080). Dr Edelson has a patent pending (ARCD. P0535US.P2) for risk stratification algorithms for hospitalized patients, research support and honoraria from Philips Healthcare (Andover, MA) and an honorarium from Early Sense (Tel Aviv, Israel), and ownership interest in Quant HC (Chicago, IL), which is developing products for risk stratification of hospitalized patients. Dr Mikkelsen has research support from the NIH. Dr Merchant has grant/research support from the NIH (K23 10714038), pilot funding from Physio-Control, Seattle, WA; Zoll Medical, Boston, MA; Cardiac Science, Bothell, WA; Philips Medical, Seattle, WA. Dr Perman has research support from the NIH (K12 HD057022). The remaining authors have no conflicts to disclose.
© 2016 The Authors.
Copyright 2020 Elsevier B.V., All rights reserved.
- Critical care
- In-hospital cardiac arrest