Elsevier

Resuscitation

Volume 150, May 2020, Pages 130-138
Resuscitation

Clinical paper
ECG-monitoring of in-hospital cardiac arrest and factors associated with survival

https://doi.org/10.1016/j.resuscitation.2020.03.002Get rights and content

Abstract

Background

ECG-monitoring is a strong predictor for 30-days survival after in-hospital cardiac arrest (IHCA). The aim of the study is to investigate factors influencing the effect of ECG-monitoring on 30-days survival after IHCA and elements of importance in everyday clinical practice regarding whether patients are ECG-monitored prior to IHCA.

Methods

In all, 19.225 adult IHCAs registered in the Swedish Registry for Cardiopulmonary Resuscitation (SRCR) were included. Cox-adjusted survival curves were computed to study survival post IHCA. Logistic regression was used to study the association between 15 predictors and 30-days survival. Using logistic regression we calculated propensity scores (PS) for ECG-monitoring; the PS was used as a covariate in a logistical regression estimating the association between ECG-monitoring and 30-days survival. Gradient boosting was used to study the relative importance of all predictors on ECG-monitoring.

Results

Overall 30-days survival was 30%. The ECG-monitored group (n = 10.133, 52%) had a 38% lower adjusted mortality (HR 0.62 95% CI 0.60−0.64). We observed tangible variations in ECG-monitoring ratio at different centres. The predictors of most relative influence on ECG-monitoring in IHCA were location in hospital and geographical localization.

Conclusion

ECG-monitoring in IHCA was associated to a 38% lower adjusted mortality, despite this finding only every other IHCA patient was monitored. The significant variability in the frequency of ECG-monitoring in IHCA at different centres needs to be evaluated in future research. Guidelines for in-hospital ECG-monitoring could contribute to an improved identification and treatment of patients at risk, and possibly to an improved survival.

Section snippets

Background

In-hospital cardiac arrest (IHCA) is associated with a high mortality, with 30-days survival figures ranging from 10 to 40%,1, 2, 3, 4, 5, 6, 7 despite the possibility of immediate recognition and initiation of peri- and post cardiac arrest care. The Swedish Registry for Cardiopulmonary Resuscitation (SRCR) reports approximately 2.500 patients suffering from IHCA in a population of about 10 million, which corresponds to an incidence of 1.7 per 1000 hospital admissions.3, 7

Factors associated

The Swedish Registry for Cardiopulmonary Resuscitation (SRCR)

We studied all IHCAs registered in the SRCR from January 1, 2008 to December 31, 2017.

The SRCR is a nationwide quality registry, launched in 1990 with the aim of studying incidence, demographics and survival in out-of hospital cardiac arrest (OHCA).7

The registry started to include IHCA in 2005 and achieved a high coverage from 2008. At present, 99% (73 out of 74) of Swedish hospitals report to the SRCR, which to date contains approximately 25.000 cases of IHCA. Registration was designed to

Patient characteristics

A total of 24.790 IHCA patients were enrolled between January 1, 2008 and December 31, 2017 in the SRCR. After applying the inclusion criteria 19.225 patients remained.

Overall, 10.133 (52%) patients were ECG-monitored. Mean age among monitored patients was 71 years, as compared to 74 years among those not monitored, and 63% of the monitored patients were men (Table 1). Previous MI was more common among patients who were monitored (25% vs 21%). Previous stroke as well as histories of diabetes,

Discussion

In this large, nationwide population-based all-encompassing registry study ECG-monitoring in IHCA was associated with a 38% lower adjusted mortality. Despite this finding, only 52% of the IHCA patients were monitored. There was a significant variation in the frequency of ECG-monitoring in IHCA at different centres.

The number of patients being ECG-monitored adjacent to IHCA has varied in previously published studies.1, 14, 23 In our study, the number of IHCA patients being ECG-monitored

Conclusion

In this nationwide, population-based all-encompassing registry study ECG-monitoring in IHCA was associated to a markedly lower adjusted mortality. Our finding that only every other IHCA patient was ECG-monitored illustrates an urge for more effective tools in order to identify at-risk patients. The predictors of most relative influence on ECG- monitoring in IHCA were location in hospital and geographical region. The significant variability in the frequency of ECG-monitoring in IHCA at different

Conflict of interest

None.

CRediT authorship contribution statement

Anna Thorén: Conceptualization, Formal analysis, Funding acquisition, Methodology, Project administration, Validation, Visualization, Writing - original draft, Writing - review & editing. Araz Rawshani: Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Validation, Visualization, Writing - review & editing. Johan Herlitz: Conceptualization, Data curation, Methodology, Project administration, Validation, Visualization,

Acknowledgements

The authors wish to acknowledge the Stockholm County and the Swedish Research Council, grant 2019-02019, for financial support. The study sponsors have not been involved in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

References (30)

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