Clinical outcomes of in-hospital cardiac arrest in a tertiary hospital and factors related to 28-day survival: A retrospective cohort study
Mehmet Nuri Yakar1, Nagihan Duran Yakar2, Müslüm Akkılıç3, Rasim Onur Karaoğlu3, Tarkan Mingir3, Namigar Turgut3
1 Department of Anaesthesiology and Reanimation, Division of Intensive Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
2 Department of Anaesthesiology and Reanimation, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
3 Department of Anaesthesiology and Reanimation, Prof. Dr. Cemil Taşçıoğlu City Hospital, University of Health Sciences, İstanbul, Turkey
Keywords: Cardiopulmonary arrest, cardiopulmonary resuscitation, code blue, intensive care, mortality
OBJECTIVES: The primary aim was to define factors related to the return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and the secondary aim was to determine factors related to 28-day mortality in patients admitted to intensive care unit (ICU) after ROSC.
METHODS: In this retrospective study, we included the patients who suffered from IHCA in a tertiary hospital between July 2016 and April 2019. Pre- and post-resuscitation characteristics of the patients and event characteristics were defined to reveal the independent factors associated with ROSC and 28-day survival.
RESULTS: A total of 254 patients (median age 73 years, 58.3% males) underwent cardiopulmonary resuscitation (CPR). The ROSC rate was 45.7%. Of all, 51 patients (median age, 63 years, 54.9% males) were admitted to in-hospital ICUs. The 28-day survival rate was 31.4%. The independent risk factors were chronic kidney disease (odds ratio [OR], 3.18, 95% confidence interval [CI], 1.37–7.19, P = 0.007), chronic obstructive pulmonary disease (OR, 2.84, 95% CI, 1.23–6.61, P = 0.015), asystole as an initial rhythm (OR, 2.94, 95% CI, 1.27–6.79, P = 0.012), multi-trauma-related complications (OR, 21.11, 95% CI, 4.71–94.69, P < 0.001), and septic shock (OR, 4.10; 95% CI, 1.16–14.54, P = 0.029) for ROSC; and a cerebral performance category score >2 (OR, 20.86, 95% CI, 2.74–158.65, P = 0.003), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 7.58, 95% CI, 1.06–54.23, P = 0.044) for 28-day mortality.
CONCLUSIONS: Independent risk factors related to ROSC and 28-day mortality were defined in the study. However, further studies are needed to devise new strategies for increased hospital discharge with preserved neurologic functions.
The study was approved by local ethics committee of Prof. Dr. Cemil Taşçıoğlu City Hospital with a decision number and date of 1268/31.04.2019.
MNY: Conceptualization (supporting), data curation (equal), formal analysis (lead), investigation (equal), methodology (supporting), validation (lead), visualization (lead), writing (lead) NDY: Conceptualization (supporting), data curation (equal), formal analysis (supporting), methodology (supporting), visualization (supporting), writing (support) MA: Data curation (equal), investigation(equal), methodology(supporting), writing(support) ROK: Data curation (equal), investigation (equal), methodology (supporting), writing (support) TM: Conceptualization (supporting), methodology (supporting), project administration (supporting), Writing – review & editing (support) NT: Conceptualization (lead), methodology (lead), project administration (lead), supervision (lead), Writing – review & editing (lead).