Advertisement

Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

      Abstract

      Background

      Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA.

      Methods

      The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA.

      Results

      We analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p < 0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p < 0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p < 0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p < 0.001) and in-hospital mortality (36.1% vs 44.1%, p < 0.001).

      Conclusion

      Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Miller P.E.
        • Chouairi F.
        • Thomas A.
        • Kunitomo Y.
        • Aslam F.
        • Canavan M.E.
        • et al.
        Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes.
        J Am Heart Assoc. 2021; 10: e018182
        • Bohula E.A.
        • Katz J.N.
        • van Diepen S.
        • Alviar C.L.
        • Baird-Zars V.M.
        • Park J.G.
        • et al.
        Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness.
        JAMA Cardiol. 2019; 4: 928-935
        • Fugate J.E.
        • Brinjikji W.
        • Mandrekar J.N.
        • Cloft H.J.
        • White R.D.
        • Wijdicks E.F.
        • et al.
        Post-cardiac arrest mortality is declining: a study of the US National Inpatient Sample 2001 to 2009.
        Circulation. 2012; 126: 546-550
        • Radeschi G.
        • Mina A.
        • Berta G.
        • Fassiola A.
        • Roasio A.
        • Urso F.
        • et al.
        Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region.
        Resuscitation. 2017; 119: 48-55
        • Nolan J.P.
        • Soar J.
        • Smith G.B.
        • Gwinnutt C.
        • Parrott F.
        • Power S.
        • et al.
        Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.
        Resuscitation. 2014; 85: 987-992
        • Beck B.
        • Bray J.
        • Cameron P.
        • Smith K.
        • Walker T.
        • Grantham H.
        • et al.
        Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry.
        Resuscitation. 2018; 126: 49-57
        • Grasner J.T.
        • Lefering R.
        • Koster R.W.
        • Masterson S.
        • Bottiger B.W.
        • Herlitz J.
        • et al.
        EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.
        Resuscitation. 2016; 105: 188-195
        • Allan K.
        • Dorian P.
        • Lin S.
        • Investigators C.S.
        Developing a Pan-Canadian Registry of Sudden Cardiac Arrest: Challenges and Opportunities.
        CJC Open. 2019; 1: 53-61
        • Andersson A.
        • Arctaedius I.
        • Cronberg T.
        • Levin H.
        • Nielsen N.
        • Friberg H.
        • et al.
        In-hospital versus out-of-hospital cardiac arrest: Characteristics and outcomes in patients admitted to intensive care after return of spontaneous circulation.
        Resuscitation. 2022; 176: 1-8
        • Merchant R.M.
        • Topjian A.A.
        • Panchal A.R.
        • Cheng A.
        • Aziz K.
        • Berg K.M.
        • et al.
        Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2020; 142: S337-S357
        • Metkus T.S.
        • Baird-Zars V.M.
        • Alfonso C.E.
        • Alviar C.L.
        • Barnett C.F.
        • Barsness G.W.
        • et al.
        Critical Care Cardiology Trials Network (CCCTN): a cohort profile.
        Eur Heart J Qual Care Clin Outcomes. 2022; 8: 703-708
        • Morrow D.A.
        • Fang J.C.
        • Fintel D.J.
        • Granger C.B.
        • Katz J.N.
        • Kushner F.G.
        • et al.
        Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association.
        Circulation. 2012; 126: 1408-1428
        • Ong M.E.
        • Shin S.D.
        • Tanaka H.
        • Ma M.H.
        • Khruekarnchana P.
        • Hisamuddin N.
        • et al.
        Pan-Asian Resuscitation Outcomes Study (PAROS): rationale, methodology, and implementation.
        Acad Emerg Med. 2011; 18: 890-897
        • Peberdy M.A.
        • Kaye W.
        • Ornato J.P.
        • Larkin G.L.
        • Nadkarni V.
        • Mancini M.E.
        • et al.
        Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.
        Resuscitation. 2003; 58: 297-308
        • Girotra S.
        • Nallamothu B.K.
        • Spertus J.A.
        • Li Y.
        • Krumholz H.M.
        • Chan P.S.
        • et al.
        Trends in survival after in-hospital cardiac arrest.
        N Engl J Med. 2012; 367: 1912-1920
        • Hoybye M.
        • Stankovic N.
        • Holmberg M.
        • Christensen H.C.
        • Granfeldt A.
        • Andersen L.W.
        In-Hospital vs. Out-of-Hospital Cardiac Arrest: Patient Characteristics and Survival.
        Resuscitation. 2021; 158: 157-165
        • Schwartz B.C.
        • Jayaraman D.
        • Warshawsky P.J.
        Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit.
        Can J Cardiol. 2013; 29: 117-121
        • Lascarrou J.B.
        • Merdji H.
        • Le Gouge A.
        • Colin G.
        • Grillet G.
        • Girardie P.
        • et al.
        Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.
        N Engl J Med. 2019; 381: 2327-2337
        • Pittl U.
        • Schratter A.
        • Desch S.
        • Diosteanu R.
        • Lehmann D.
        • Demmin K.
        • et al.
        Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial.
        Clin Res Cardiol. 2013; 102: 607-614
        • Panchal A.R.
        • Bartos J.A.
        • Cabanas J.G.
        • Donnino M.W.
        • Drennan I.R.
        • Hirsch K.G.
        • et al.
        Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2020; 142: S366-S468
        • Sinha S.S.
        • Sukul D.
        • Lazarus J.J.
        • Polavarapu V.
        • Chan P.S.
        • Neumar R.W.
        • et al.
        Identifying Important Gaps in Randomized Controlled Trials of Adult Cardiac Arrest Treatments: A Systematic Review of the Published Literature.
        Circ Cardiovasc Qual Outcomes. 2016; 9: 749-756
        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • Cronberg T.
        • Moulaert V.R.
        • Deakin C.D.
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.
        Resuscitation. 2015; 95: 202-222
        • Donnino M.W.
        • Andersen L.W.
        • Berg K.M.
        • Reynolds J.C.
        • Nolan J.P.
        • Morley P.T.
        • et al.
        Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care.
        Perioperat Resusc Resusc. 2016; 98: 97-104
        • Kim W.Y.
        • Ahn S.
        • Hong J.S.
        • Cho G.C.
        • Seo D.W.
        • Jeung K.W.
        • et al.
        The impact of downtime on neurologic intact survival in patients with targeted temperature management after out-of-hospital cardiac arrest: National multicenter cohort study.
        Resuscitation. 2016; 105: 203-208
        • Donnino M.W.
        • Salciccioli J.D.
        • Dejam A.
        • Giberson T.
        • Giberson B.
        • Cristia C.
        • et al.
        APACHE II scoring to predict outcome in post-cardiac arrest.
        Resuscitation. 2013; 84: 651-656
        • Zive D.
        • Koprowicz K.
        • Schmidt T.
        • Stiell I.
        • Sears G.
        • Van Ottingham L.
        • et al.
        Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest.
        Resuscitation. 2011; 82: 277-284
        • Elmer J.
        • Torres C.
        • Aufderheide T.P.
        • Austin M.A.
        • Callaway C.W.
        • Golan E.
        • et al.
        Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest.
        Resuscitation. 2016; 102: 127-135