While overall survival for in-hospital cardiac arrest has improved, patients who arrest during nights or weekends continue to experience lower survival compared to patients who arrest during daytime hours, according to a study published Jan. 22 in the Journal of the American College of Cardiology.

Uchenna R. Ofoma, MD, MS, et al., identified 151,071 patients at least 18 years old who experienced in-hospital cardiac arrest between January 2000 and December 2014 using the GWTG-Resuscitation registry. More than half of the patients experienced cardiac arrest during off-hours. Overall, 62.4 percent of patients survived acute resuscitation efforts and 18.6 percent survived to hospital discharge. Both on- and off-hours groups had a similar prevalence of co-morbidities, location of arrest and interventions in place at time of arrest.

Results showed that survival to discharge increased in both groups over the 15-year study period -- for on-hours: from 16 percent in 2000 to 25.2 percent in 2014; for off-hours: 11.9 percent in 2000 to 21.9 percent in 2014. However, the survival during off-hours remained significantly lower compared to on-hours.

According to the researchers, poor survival during off-hours is likely due to several factors: changes to hospital staffing patterns during nights and weekends; physicians workings nights and weekends provide coverage to patients they may be less familiar with; nurse-to-patient ratios are lower during off-hours; and the impact of shift work, particularly during nighttime, has been shown to impact psychomotor skills and performance of skilled activities, such as cardiopulmonary resuscitation.

In an editorial accompanying the study, Julia H. Indik, MD, PhD, FACC, said we must analyze the systems of care in hospitals with the smallest gaps in survival between on- and off-hours patients. She explains that an analysis of these hospitals may identify system characteristics that allow for the design and testing of future system protocols for the in-hospital cardiac arrest patient.

"A gap still remains for survival for cardiac arrests that occur at night or on a weekend. To close this gap will require that we identify the barriers so that new hospital protocols can be made. Time is of the essence," Indik said.

Keywords: Prevalence, Research Personnel, Cardiopulmonary Resuscitation, Heart Arrest, Patient Discharge, Registries

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