Trends in survival after in-hospital cardiac arrest
Open accessAbstract
BACKGROUND: Despite advances in resuscitation care in recent years, it is not clear whether survival and neurologic function after in-hospital cardiac arrest have improved over time. METHODS: We identified all adults who had an in-hospital cardiac arrest at 374 hospitals in the Get with the Guidelines-Resuscitation registry between 2000 and 2009. Using multivariable regression, we examined temporal trends in risk-adjusted rates of survival to discharge. Additional analyses explored whether trends were due to improved survival during acute resuscitation or postresuscitation care and whether they occurred at the expense of greater neurologic disability in survivors. RESULTS: Among 84,625 hospitalized patients with cardiac arrest, 79.3% had an initial rhythm of asystole or pulseless electrical activity, and 20.7% had ventricular fibrillation or pulseless ventricular tachycardia. The proportion of cardiac arrests due to asystole or pulseless electrical activity increased over time (P<0.001 for trend). Risk-adjusted rates of survival to discharge increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval [CI], 1.03 to 1.06; P<0.001 for trend). Survival improvement was similar in the two rhythm groups and was due to improvement in both acute resuscitation survival and postresuscitation survival. Rates of clinically significant neurologic disability among survivors decreased over time, with a risk-adjusted rate of 32.9% in 2000 and 28.1% in 2009 (adjusted rate ratio per year, 0.98; 95% CI, 0.97 to 1.00; P=0.02 for trend). CONCLUSIONS: Both survival and neurologic outcomes after in-hospital cardiac arrest have improved during the past decade at hospitals participating in a large national quality-improvement registry. (Funded by the American Heart Association.).
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The AHA GWTG-Resuscitation registry documented that 84.6% of cardiac arrests occurred in monitored areas in 2007-2009.
“This is in marked contrast to the AHA GWTG-Resuscitation registry, which, in the most recently reported period (2007-2009), documented that 84.6% of cardiac arrests occurred in monitored areas.”
From Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit (2014) · cites this paper as [5]
Unadjusted survival to hospital discharge from a shockable rhythm was higher in the UK (49.0% versus 37.2%).
“However, unadjusted survival to hospital discharge from a shockable rhythm was higher in the UK (49.0% versus 37.2%).”
From Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit (2014) · cites this paper as [5]
The proportion of cases with a shockable first documented rhythm of VF/VT was similar in NCAA compared with the GWTG-Resuscitation registry (16.9% and 18.5%, respectively).
“The proportion of cases with a shockable first documented rhythm of VF/VT was similar in NCAA compared with the GWTG-Resuscitation registry (16.9% and 18.5%, respectively).”
From Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit (2014) · cites this paper as [5]
The proportion of patients classified as CPC 1 in NCAA is considerably higher than other studies.
“The proportion of patients classified as CPC 1 in NCAA is considerably higher than other studies - for example, in 2007-2009, the AHA GWTG-Resuscitation registry reported that 51.3% of hospital survivors were assessed as CPC 1 and 19.5% were CPC 3 or worse.”
From Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit (2014) · cites this paper as [5]
Unadjusted hospital survival in the UK appears remarkably similar to that reported for adult in-hospital cardiac arrests from the AHA GWTG-Resuscitation registry in 2009 (18.6%).
“Despite these differences in scope, unadjusted hospital survival in the UK appears remarkably similar to that reported for adult in-hospital cardiac arrests from the AHA GWTG-Resuscitation registry in 2009 (18.6%).”
From Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit (2014) · cites this paper as [5]
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“While the number of IHCA has risen in the past two decades, the survival to hospital discharge rate has also increased from roughly 13%–25% (Benjamin et al., 2019; Girotra et al., 2012; Neagle & Wachsberg, 2010).”
BackgroundSelf-citation
- Authors
- Girotra, S., Nallamothu, B. K., Spertus, J. A., Li, Y., Krumholz, H. M., & Chan, P. S.
- Affiliations
- University of Iowa Hospitals and Clinics (US)
- University of Michigan (US)
- University of Missouri–Kansas City (US)
- Yale New Haven Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-11-15
- Volume
- 367
- Issue
- 20
- Pages
- 1912-1920
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3517894
- OpenAlex
- W2143932987
- Cited by
- 895
- References
- 28
- Citations by year
- 2026: 42 · 2025: 50 · 2024: 48 · 2023: 59 · 2022: 55 · 2021: 70 · 2020: 81 · 2019: 74 · 2018: 74 · 2017: 78 · 2016: 70 · 2015: 83 · 2014: 70 · 2013: 37 · 2012: 3
- FWCI
- 68.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL102224)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Physical Sciences › Engineering › Biomedical Engineering › Mechanical Circulatory Support Devices
- Keywords
- in-hospital cardiac arrest, survival to hospital discharge, neurodisability, temporal trends, post-resuscitation care, asystole, pulseless electrical activity, ventricular fibrillation, pulseless ventricular tachycardia, quality improvement
- MeSH terms
- Adult, Aged, Female, Heart Arrest, Hospitalization, Humans, Male, Middle Aged, Nervous System Diseases, Patient Discharge, Registries, United States, Survival Analysis, Hospital Mortality, Risk Adjustment, Quality Improvement
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