Abstract 15948: Frequency and Prognosis of Recurrent In-hospital Cardiac Arrest
Introduction: Nearly 200,000 patients experience an in-hospital cardiac arrest (IHCA) annually in the U.S. However, the proportion of patients who experience a recurrent IHCA and the associated prognosis with a recurrent cardiac arrest is unknown.
Methods: Within Get With The Guidelines-Resuscitation, we identified 192,250 patients with an IHCA between 2000 to 2014. Patients were categorized as having no recurrent IHCA (only 1 event), a recurrent IHCA (2 or more events), and a recurrent out-of-hospital cardiac arrest (OHCA), defined as an IHCA after being hospitalized for an index OHCA. Using multivariable hierarchical logistic regression models, rates of survival to discharge and favorable neurological survival (discharge CPC score of 1) between patients with recurrent IHCA and those with no recurrent IHCA and recurrent OHCA were compared.
Results: Overall, 165,446 (86.1%) had no recurrent IHCA, 23,643 (12.3%) had recurrent IHCA, and 3162 (1.6%) had recurrent OHCA. Patients with no recurrent IHCA were older than those with recurrent IHCA or OHCA (mean ages of 66.1, 63.3, and 61.9, respectively) but had lower rates of hypotension and respiratory insufficiency. Unadjusted rates of survival to discharge were 22.1%, 12.7%, and 16.1% and of favorable neurological discharge were 11.1%, 5.7%, and 6.3% for those with no recurrent IHCA, recurrent IHCA, and recurrent OHCA, respectively. Compared with patients with no recurrent IHCA, patients with recurrent IHCA were less than half as likely to survive to discharge (adjusted OR: 0.48 [0.46, 0.50] P<0.001) and to have favorable neurological survival (adjusted OR: 0.44 [0.41, 0.47] P<0.001). Compared with patients with recurrent OHCA, patients with recurrent IHCA also had lower rates of survival to discharge (adjusted OR: 0.87 [0.77, 0.98] P=0.03) and favorable neurological survival (adjusted OR: 0.64 [0.53, 0.78] P<0.001).
Conclusions: Nearly 1 in 8 patients with an IHCA has a recurrent IHCA. Patients with recurrent IHCA have significantly lower rates of survival to discharge and favorable neurological survival than patients with only a single IHCA and those with recurrent IHCA after an OHCA. These findings provide important prognostic information for clinicians and families of patients with IHCA.
Author Disclosures: M.L. Chan: None. Y. Tang: None. M. Anderson: None. P.S. Chan: Research Grant; Significant; NHLBI.
- © 2016 by American Heart Association, Inc.