Clinical InvestigationAcute Ischemic Heart DiseaseCardiac arrest outside and inside hospital in a community: Mechanisms behind the differences in outcome and outcome in relation to time of arrest
Section snippets
Out-of-hospital cardiac arrest
All consecutive cases of cardiac arrest in Göteborg to which the Emergency Medical Service (EMS) system attempted resuscitation between January 1, 1994, and December 31, 2006, were followed up for 1 year. We collected background data from the EMS logbook. We gathered data from the ambulance trip sheet, hospital records, and death certificates. The data were transferred to a database following a formal protocol.
Study area and OHCA population
Göteborg is a city with an area of 455 km2. The resident population is around
Results
In total, 2,984 cases of OHCA and 1,478 cases of IHCA were included in the survey.
In all, 8.2% of patients survived the OHCA to 1 month, whereas 39.7% survived an IHCA to hospital discharge. Information on survival was missing in 22 and 6 cases, respectively. Because the catchment populations were 500,000 and 250,000, respectively, this indicated that 4 persons per 100,000 inhabitants and year were resuscitated after an OHCA and 17 after an IHCA. Therefore, a total of 21 persons per 100,000
Discussion
This study is unique in that it describes the characteristics of and outcome among patients suffering from IHCA and OHCA within the same community over a 12-year period. Results indicate that, in our practice settings, overall survival is about 5 times higher when cardiac arrest occurs in-hospital compared with outside hospital. They further suggest that about 17 patients per 100,000 inhabitants and year can survive an IHCA versus 4 patients per 100,000 inhabitants and year in the case of an
Conclusions
Compared with outside hospital, patients who suffer a cardiac arrest inside a hospital have a greater probability of survival (3 times as high in a shockable rhythm and 7 times as high if found with a nonshockable rhythm) in our practice setting.
The rescue team's response time appears to be inversely related to survival both in and outside hospital when patients are found in a shockable rhythm.
The increased survival after IHCA was only partly explained by more rapid treatment among patients
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Cited by (52)
In-hospital versus out-of-hospital cardiac arrest: Characteristics and outcomes in patients admitted to intensive care after return of spontaneous circulation
2022, ResuscitationCitation Excerpt :Survival curves did not differ significantly, likely due to the long follow-up times for survival or limited sample size. Other studies have reported similar short-term mortality (at hospital discharge or 30 days) in IHCA and OHCA,13,15,16 whereas a good neurological outcome (commonly assessed at hospital discharge) was more common among survivors of IHCA than OHCA.10,11 Possible explanations for differences in outcomes include hospital rates of DNR-orders and routines for termination-of-resuscitation, affecting which patients eventually were admitted to intensive care, as well as patient management during the ICU-stay.
Socioeconomic status and in-hospital cardiac arrest: A systematic review
2020, Resuscitation PlusCitation Excerpt :SES has been observed to be associated with risk of and outcomes after out-of-hospital cardiac arrest (OHCA),3 and previous studies have also identified socioeconomic disparities in numerous other acute conditions including sepsis4–6 and acute myocardial infarction.7,8 However, in-hospital cardiac arrest (IHCA) may differ from OHCA in both patient and disease characteristics, including comorbidities, proportion of witnessed arrests, time to cardiopulmonary resuscitation, and outcomes.9–12 Thus, little is known about the association between SES and risk of and outcomes after IHCA.