Elsevier

Resuscitation

Volume 155, October 2020, Pages 48-54
Resuscitation

Clinical paper
Survival and functional outcome at hospital discharge following in-hospital cardiac arrest (IHCA): A prospective multicentre observational study

https://doi.org/10.1016/j.resuscitation.2020.07.007Get rights and content

Abstract

Aim

To evaluate the functional outcome of patients after in-hospital cardiac arrest (IHCA) and to identify associations with good functional outcome at hospital discharge.

Method

Emergency calls were prospectively screened and data collected for IHCAs in seven Australian hospitals. Patients were included if aged > 18 years, admitted as an acute care hospital in-patient and experienced IHCA; defined by a period of unresponsiveness with no observed respiratory effort and commencement of external cardiac compressions. Data collected included patient demographics, clinical and cardiac arrest characteristics, survival and functional outcome at hospital discharge using the modified Rankin Scale (mRS) and Katz Index of Independence in ADLs (Katz-ADL).

Results

152 patients suffered 159 IHCAs (male 66.4%; mean age 70.2 (± 13.9) years). Sixty patients (39.5%) survived, of whom 43 (71.7%) had a good functional outcome (mRS ≤ 3) and 38 (63.3%) were independent with activities of daily living (ADLs) at hospital discharge (Katz-ADL = 6). Younger age (OR 0.95; 95% CI 0.91−0.98; p = 0.003), shorter duration of CPR (OR 0.84; 95% CI 0.77−0.91; p < 0.0001) and shorter duration of hospital admission prior to IHCA (OR 0.96; 95% CI 0.93−0.998; p = 0.04) were independently associated with a good functional outcome at hospital discharge.

Conclusion

The majority of survivors had a good functional outcome and were independent with their ADLs at hospital discharge. Factors associated with good functional outcome at hospital discharge were identified.

Introduction

In Australia and New Zealand, the estimated incidence of in-hospital cardiac arrests (IHCA) is 1.3–6.0 per 1000 hospital admissions.1 Although survival rates appear to be improving,2, 3, 4 outcomes for those who experience an IHCA remain poor, with recent studies reporting survival to hospital discharge to be approximately 20–25%.1, 3 Despite this, IHCA has received relatively little attention compared to out-of-hospital cardiac arrest (OHCA) and to date there are few randomised controlled trials specific to IHCA populations.5

Studies of IHCA most commonly report physiological outcomes and survival status as the primary endpoints. Functional outcome is less frequently reported and is typically assessed at hospital discharge using the cerebral performance category (CPC) as recommended by The Utstein Guidelines for the standardised reporting of cardiac arrest outcomes.6 However, in the recent Core Outcome Set for Cardiac Arrest (COSCA) publication, the modified Rankin Scale (mRS) was recommended as a more granular tool to assess functional outcome following cardiac arrest.7 The mRS is a measure of global disability that has been validated in stroke and brain injury populations.8, 9 It captures both physical and cognitive impairments and is able to discriminate between mild and moderate disability.8

We have recently reported on the epidemiology of IHCAs amongst seven hospitals in Australia equipped with mature rapid response systems.10 The aim of this study was to evaluate the functional outcome of patients following IHCA using the mRS and to identify associations with good functional outcome at hospital discharge.

Section snippets

Study design

A prospective multicentre observational study (ANZ-CODE) was conducted between 1st July 2017 and 9th August 2018 evaluating adult (≥18 years old) patients experiencing IHCA. The recruitment period for each site varied and was dependent on time taken to obtain ethics approval and available resources for data collection. Ethics approval was obtained at the lead site (Austin Health; HREC/16/Austin/168) and all participating sites. The conduct, governance, ethics approval, method and data collected

Details of patient cohort

During the study period, 152 patients had 159 IHCAs. Demographic data are available in Table 1. Prior to the IHCA, 10 (6.6%) patients had a treatment limitation order in place, 24 (15.8%) were in paid employment, and 119 (78.3%) were documented as being independent with ADLs prior to hospital admission. The median (IQR) hospital length of stay (LOS) prior to IHCA was 4 (1–12) days, 65 (42.8%) patients were monitored at the time of IHCA and 116 (76.3%) IHCAs were witnessed. Two thirds of

Key findings

In this multicentre cohort study of IHCA, 40% of patients survived and the majority of survivors had a good functional outcome and were independent with their ADLs at hospital discharge. Two-thirds of survivors were discharged directly home but nearly a third had a reduced level of independence at hospital discharge compared to admission, with some patients requiring full assistance with their ADLs. We found younger age, shorter duration of CPR and shorter duration of hospital admission prior

Conclusion

Survival to hospital discharge following IHCA was 40%. The majority of survivors had a good functional outcome and were independent with their ADLs at hospital discharge. Younger age, shorter duration of CPR and shorter duration of hospital admission prior to IHCA were associated with a good functional outcome at hospital discharge.

Conflicts of interest

None.

CRediT authorship contribution statement

G. Pound: Conceptualization, Formal analysis, Investigation, Writing - original draft, Visualization, Project administration. D. Jones: Conceptualization, Methodology, Validation, Investigation, Writing - review & editing, Visualization, Supervision, Project administration. G.M. Eastwood: Investigation, Writing - review & editing, Visualization, Supervision, Project administration. E. Paul: Formal analysis, Writing - review & editing, Visualization. C.L. Hodgson: Validation, Investigation,

References (38)

Cited by (22)

  • Quality of life and functional outcomes after in-hospital cardiopulmonary resuscitation. A systematic review

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    Seven studies used data from national CPR registries.9,11–13,19–21 Sixteen studies report measures of neurological functioning,3,4,9–13,16–21,23,25,27 four studies report on discharge to supportive living environment as a proxy for functional abilities,8,14,16,17 a single study reported on health-related QoL,15 and one study reported performance of activities of daily living.28 No studies contained self-reported QoL, psychological symptoms or wellbeing.

  • Functional outcomes following an in-hospital cardiac arrest: A retrospective cohort study

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    Such variance highlights the need for data to be specific to individual countries, thus allowing targeted strategies to be used to improve outcomes. With respect to this, only two studies have described functional outcomes for survivors of IHCA in Australia, with 93% and 72% of patients, respectively, having a favourable functional outcome at discharge.6,7 Furthermore, no known published studies of functional outcomes after an IHCA have been conducted outside of metropolitan centres despite it being known that those living in rural areas have worse health outcomes than their metropolitan counterparts.8

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1

The complete list of the ANZ-CODE Investigators is given in Appendix A.

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