Clinical paperECG-monitoring of in-hospital cardiac arrest and factors associated with 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)
- et al.
Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden — a population-based register study of more than 18,000 cases
Int J Cardiol
(2018) - et al.
Adult in-hospital cardiac arrest in Denmark
Resuscitation
(2019) - et al.
Trends in co-morbidities and survival for in-hospital cardiac arrest — a Swedish cohort study
Resuscitation
(2018) - et al.
Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: a nationwide study with the emphasis on gender and age
Am J Emerg Med
(2017) - et al.
Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital
Resuscitation
(2002) - et al.
The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest
Resuscitation
(2016) - et al.
Preceding national early warnings scores among in-hospital cardiac arrests and their impact on survival
Am J Emerg Med
(2017) - et al.
European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support
Resuscitation
(2015) In-hospital cardiac arrest: is it time for an in-hospital ‘chain of prevention’?
Resuscitation
(2010)- et al.
The impact of telemetry on survival of in-hospital cardiac arrests in non-critical care patients
Resuscitation
(2013)
Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR
Resuscitation
Evaluation of pre-arrest morbidity score and prognosis after resuscitation score and other clinical variables associated with in-hospital cardiac arrest in southern Sweden
Resuscitation
A 20-year perspective of in hospital cardiac arrest: experiences from a university hospital with focus on wards with and without monitoring facilities
Int J Cardiol
Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style
Resuscitation
Stochastic gradient boosting
Comput Stat Data Anal
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