Abstract 11152: Trends in Survival After In-Hospital Cardiac Arrest
BACKGROUND: Despite numerous advances in resuscitation care in recent years, it remains controversial whether survival after in-hospital cardiac arrest has improved over time.
METHODS: We identified all adults with an index 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 in this cohort. Additional analyses explored whether these trends were: (1) due to improvement in survival immediately after the acute resuscitation or during post-resuscitation care, and (2) occurring at the expense of greater neurological disability among survivors.
RESULTS: Among 84,625 patients with in-hospital cardiac arrest, 67,135 (79.3%) had an initial non-shockable rhythm (asystole or pulseless electrical activity) while 17,490 (20.7%) had a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia). The proportion of cardiac arrests due to non-shockable rhythms increased over time (68.7% in 2000, 82.4% in 2009, P for trend <0.01). Risk-adjusted rates of survival to discharge increased from 14.0% in 2000 to 19.1% in 2009 (adjusted rate ratio per 1-year: 1.04, 95% CI [1.02-1.05]; P for trend <0.01). This improvement was consistent in both rhythm groups (Figure) and was largely due to increased survival immediately after the acute resuscitation (risk-adjusted rates: 40.3% in 2000, 56.7% in 2009; adjusted rate ratio per 1-year: 1.03, 95% CI [1.02-1.04]; P for trend <0.01). Importantly, rates of neurological disability at discharge remained unchanged over time despite overall improved survival (risk-adjusted rates: 52.2% in 2000, 49.3% in 2009; adjusted rate ratio per 1-year: 0.99, 95% CI [0.98-1.01]; P for trend 0.45).
CONCLUSIONS: Survival after in-hospital cardiac arrest has increased significantly over the past decade without increased rates of neurological disability.
- © 2011 by American Heart Association, Inc.