Trends in Survival After In-Hospital Cardiac Arrest

Nov 14, 2012
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Authors:
Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, on behalf of the American Heart Association Get With the Guidelines-Resuscitation Investigators.
Citation:
N Engl J Med 2012;367:1912-1920.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What are temporal trends in rates of survival to hospital discharge among adults following in-hospital cardiac arrest at hospitals participating in the Get With the Guidelines-Resuscitation national quality improvement registry?

Methods:

This was an analysis of all adults who had an in-hospital index pulseless cardiac arrest occurring in intensive care or inpatient ward settings at 374 hospitals in the Get With the Guidelines-Resuscitation registry between 2000 and 2009. Multivariable regression analysis was used to explore temporal trends in risk-adjusted acute resuscitation or post-resuscitation survival. Neurologic disability among survivors was also assessed with the cerebral-performance category (CPC) scores.

Results:

Risk-adjusted rates of survival to discharge increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval [CI], 1.03-1.06; p < 0.001 for trend). There was a parallel decrease in clinically significant neurologic disability among survivors, with risk-adjusted rates decreasing from 32.9% in 2000 to 28.1% in 2009 (adjusted rate ratio per year, 0.98; 95% CI, 0.97-1.00; p = 0.02 for trend). Survival after cardiac arrest was independent of whether the pulseless rhythm was treatable by defibrillation.

Conclusions:

Among hospitals participating in the Get With the Guidelines-Resuscitation registry, both survival and neurologic outcomes after in-hospital cardiac arrest have improved substantially between 2000 and 2009.

Perspective:

While limited by the possibility of residual confounding (despite adjusting for relevant variables) and missing information on specific resuscitation-process variables, the present study offers convincing evidence of improved survival following in-hospital cardiac arrest, with parallel improvement in neurologic outcomes. Factors (e.g., delivery of high-quality chest compressions) other than prompt defibrillation may be responsible for these temporal gains, as survival improved regardless of the nonperfusing rhythm.

Keywords: Survivors, Registries, Cardiopulmonary Resuscitation, Electric Countershock, Heart Arrest, Confidence Intervals, Inpatients, Regression Analysis


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