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
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Article info
Publication history
Published online: December 12, 2022
Accepted:
December 5,
2022
Received in revised form:
November 19,
2022
Received:
October 10,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
