Journal article
Trends in Survival after In-Hospital Cardiac Arrest
The New England journal of medicine, Vol.367(20), pp.1912-1920
2012
DOI: 10.1056/NEJMoa1109148
PMCID: PMC3517894
PMID: 23150959
Abstract
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.
Details
- Title: Subtitle
- Trends in Survival after In-Hospital Cardiac Arrest
- Creators
- Saket GIROTRA - University of Iowa Hospitals and Clinics, Iowa City, United StatesBrahmajee K NALLAMOTHU - Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the University of Michigan Division of Cardiovascular Medicine, Ann Arbor, United StatesJohn A SPERTUS - Saint Luke's Mid America Heart Institute, United StatesYAN LI - Saint Luke's Mid America Heart Institute, United StatesHarlan M KRUMHOLZ - Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and the Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, and the Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United StatesPaul S CHAN - Saint Luke's Mid America Heart Institute, United StatesAmerican Heart Association Get with the Guidelines–Resuscitation Investigators
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.367(20), pp.1912-1920
- Publisher
- Massachusetts Medical Society
- DOI
- 10.1056/NEJMoa1109148
- PMID
- 23150959
- PMCID
- PMC3517894
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Language
- English
- Date published
- 2012
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094708302771
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