Abstract 350: Hospital Variation in Survival for Pediatric In-Hospital Cardiac Arrest: A Report From Get With the Guidelines -Resuscitation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Natalie Jayaram ◽  
John A Spertus ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
National Registry ◽  
High Performing ◽  
Hierarchical Logistic Regression ◽  
Hospital Survival ◽  
Hospital Variation ◽  
C Statistic ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,640 cardiac arrests in children from 168 hospitals from 2006 to 2010. Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge. We then applied the coefficients and random hospital intercepts from the model to examine risk-standardized rates of cardiac arrest survival for those hospitals with a minimum of 10 pediatric cardiac arrest cases. Results: A total of 15 patient-level predictors were identified: age, sex, race, cardiac arrest rhythm, location and day of arrest, mechanical ventilation, baseline depression in neurological function, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, and use of intravenous antiarrhythmics or vasopressors at the time of arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 31 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 21% to 44%; range: 0% to 59%). After risk-standardization, variation in hospital survival rates persisted (median, 37%; IQR: 33% to 41%; range: 31% to 49%), although the range of outcomes narrowed considerably. Conclusion: In a large national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. Even with risk-standardization, there is significant variation in survival rates across hospitals. Leveraging these models, best practices can be assessed at high-performing hospitals and shared with others to improve care in the setting of pediatric cardiac arrest.

Abstract 252: The Association of Award Recognition From Get With the Guidelines-Resuscitation with Improved Survival Rates in In-Hospital Cardiac Arrest Events

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Kathie Thomas ◽  
Art Miller ◽  
Greg Poe
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Survival Rate ◽  
Discharge Rate ◽  
Survival Rates ◽  
Improvement Program ◽  
Award Winning ◽  
National Survival ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background and Objectives: It is estimated that over 200,000 adults experience in-hospital cardiac arrest each year. Overall survival to discharge has remained relatively unchanged for decades and survival rates remain at about 20% (Elenbach et al., 2009). Get With The Guidelines-Resuscitation (GWTG-R) is an in-hospital quality improvement program designed to improve adherence to evidence-based care of patients who experience an in-hospital resuscitation event. GWTG-R focuses on four achievement measures. The measures for adult patients include time to first chest compression of less than or equal to one minute, device confirmation of correct endotracheal tube placement, patients with pulseless VF/VT as the initial documented rhythm with a time to first shock of less than or equal to two minutes, and events in which patients were monitored or witnessed at the time of cardiac arrest. The objective of this abstract is to examine the association between hospital adherence to GWTG-R and in-hospital cardiac arrest survival rates. Methods: A retrospective review of adult in-hospital cardiopulmonary arrest (CPA) patients (n=1849) from 21 Michigan, Illinois, and Indiana hospitals using the GWTG-R database was conducted from January 2014 through December 2014. This study included adult CPA patients that did and did not survive to discharge. Results: The review found that hospitals that had attained 84.6% or higher thresholds in all four achievement measures for at least one year, which is award recognition status, had a significantly improved in-hospital CPA survival to discharge rate of 29.6%. Hospitals that did not obtain award status had a CPA survival to discharge rate of 24.3%. The national survival rate for in-hospital adult CPA survival to discharge is 20%. Hospitals that did not achieve award recognition status still demonstrated improvement in survival rate when compared to the national survival rate, indicating the importance of a quality improvement program such as GWTG-R. No significant difference was found between in-hospital adult CPA survival rate and race between GWTG-R award winning and non-award winning hospitals. Hospitals that earned award recognition from GWTG-R had a survival to discharge rate of 30.2% for African Americans and 29.6% for whites. Hospitals that were did not earn award recognition from GWTG-R had a survival to discharge rate of 20.0% for African Americans and 20.1% for whites. Conclusions: Survival of in-hospital adult CPA patients improved significantly when GWTG-R measures are adhered to. Survival of in-hospital adult CPA patients also improves with implementation of GWTG-R. It is crucial that hospitals collect and analyze data regarding resuscitation processes and outcomes. Quality improvement measures can then be implemented in order to assist with improving in-hospital CPA survival rates.

Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Abdul H Qazi ◽  
Yunshu Zhou ◽  
Paul Chan ◽  
Saket Girotra
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Time Intervals ◽  
Hierarchical Regression Model ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( > 25 percentile points) at 26.8% and by at least 2 quartiles ( > 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

Abstract 220: Missed Opportunity for Medical Emergency Team Activation in Pediatric In-Hospital Cardiac Arrest

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Natalie Jayaram ◽  
Maya L Chan ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
National Registry ◽  
Medical Emergency ◽  
Missed Opportunities ◽  
Emergency Team ◽  
Variable Success ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Prior studies of Medical Emergency Teams (METs) in pediatric hospitals have shown inconsistent results in terms of their ability to improve outcomes. Whether the variable success is due to differential utilization of METs among hospitals is unknown. Methods: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children (age <18 years) with an in-hospital cardiac arrest (IHCA) on the general inpatient or telemetry floors from 2007 to 2014. In cases of IHCA where MET evaluation did not occur, we examined the frequency of “missed” opportunities for activation of the MET based upon the presence of one or more abnormal vital signs. We also examined the variability in utilization of the MET among those hospitals with at least ten cases of IHCA. Results: Of 215 children from 23 hospitals sustaining an IHCA, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to IHCA were older (6.8 ± 6.5 vs. 3.1 ± 4.7, p < 0.001) and were more likely to have metabolic/electrolyte abnormalities (9/48 [18.8%] vs. 9/167 [5.4%], p=0.006), sepsis (8/48 [16.7%] vs. 8/167 [4.8%], p=0.01), or malignancy (11/48 [22.9%] vs. 9/167 [5.4%], p<0.001) at the time of their IHCA. Hospital utilization of the MET varied substantially (median 20%; inter-quartile range [IQR]: 3.4%-29.8%; range: 0%-36.4%). Among patients who did not have a MET called prior to their IHCA, 78/141 (55.3%) had at least one abnormal vital sign that should have triggered a MET. Conclusion: In a large, national registry, we found that the majority of pediatric IHCA cases are not preceded by a MET evaluation despite meeting criteria that should have triggered a MET. Improved utilization of the MET by all hospitals could lead to fewer pediatric IHCA and improved outcomes following pediatric IHCA.

scholarly journals Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease

Resuscitation ◽  
2013 ◽  
Vol 84 (5) ◽  
pp. 569-574 ◽  
Author(s):  
M.T. Blom ◽  
M.J. Warnier ◽  
A. Bardai ◽  
J. Berdowski ◽  
R.W. Koster ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pulmonary Disease ◽  
Survival Rates ◽  
Obstructive Pulmonary Disease ◽  
Hospital Survival ◽  
Hospital Cardiac Arrest

Abstract 114: Does Size Matter? Comparing Cardiac Arrest Survival to Discharge Rates Based on Number of Hospital Beds

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Kathie Thomas ◽  
Renaud Gueret ◽  
Art Miller ◽  
Gary Myers
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
The United States ◽  
Spontaneous Circulation ◽  
Stressful Event ◽  
Successful Resuscitation ◽  
Discharge Rates ◽  
Get With The Guidelines ◽  
Size Matter ◽  
Hospital Cardiac Arrest

Background and Objectives: In-hospital cardiac arrest can be challenging. The frequency of events outside of critical care units is typically low which makes it a stressful event for staff. According to the HEROIC study, there were 209,000 in-hospital cardiac arrests in the United States in 2016. Only 24.9% survived. Get With the Guidelines-Resuscitation is a quality improvement tool for hospitals to measure and evaluate their in-house codes and resuscitation rates. It may be assumed that survival rates are better at larger hospitals. The objective of this study was to examine the association between in-hospital cardiac arrest rates based on the bed size of a hospital. Methods: By using number of beds as a comparison and data from Get With the Guidelines-Resuscitation we sampled 46 hospitals in the eleven-state AHA Midwest Affiliate, (IL, IN, IA, KS, MI, MN, MO, NE, ND, SD, WI), comparing survival to discharge from cardiac arrest, with and without shockable rhythms from January 1, 2013-December 31, 2016. All patients are included in a risk adjusted formula that resides within Get With the Guidelines-Resuscitation. Results: In our comparison, we included hospitals with licensed and/or staffed beds of <100, 100-199, 200-299, 300-399 and 400 or more beds. Our data showed that higher sustained return of spontaneous circulation rates with survival to discharge are not dictated by the size of a hospital. In fact, in all 4 years shown, successful resuscitation rates were higher at hospitals with fewer beds verses larger facilities. Conclusions: Survival to discharge from in-hospital cardiac arrest is not dependent on hospital bed size. It is important that hospitals collect and analyze data regarding in-hospital cardiac arrests to improve survival rates beyond the 24.9% identified in the HEROIC study. A further examination looking at discharge destinations with CPC scores should be considered for a future study.

scholarly journals Association Between Hospital Resuscitation Champion and Survival for In‐Hospital Cardiac Arrest

2021 ◽  
Author(s):  
Jesse L. Chan ◽  
Jessica Lehrich ◽  
Brahmajee K. Nallamothu ◽  
Yuanyuan Tang ◽  
Mary Kennedy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Survival Rates ◽  
Critical Factor ◽  
Survival Outcomes ◽  
Study Cohort ◽  
Calculated Risk ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background Although many hospitals have resuscitation champions, it is unknown if hospitals with very active physician or nonphysician champions have higher survival rates for in‐hospital cardiac arrest (IHCA). Methods and Results We surveyed adult hospitals in Get With The Guidelines‐Resuscitation about resuscitation practices, including about their resuscitation champion. Hospitals were categorized as having a very active physician champion, a very active nonphysician champion, or other (no champion or not very active champion). For each hospital, we calculated risk‐standardized survival rates for IHCA during the period of 2016 to 2018 and categorized them into quintiles of risk‐standardized survival rates. The association between a hospital's resuscitation champion type and their quintile of survival was evaluated using multivariable hierarchical proportional odds logistic regression. Overall, 192 hospitals (total of 44 477 IHCAs) comprised the study cohort. Risk‐standardized survival rates for IHCA varied widely between hospitals (median: 24.7%; range: 9.2%–37.5%). Very active physician champions were present in 29 (15.1%) hospitals, 64 (33.3%) had very active nonphysician champions, and 99 (51.6%) did not have a very active champion. Compared with sites without a very active resuscitation champion, hospitals with a very active physician champion were 4 times more likely to be in a higher survival quintile, even after adjusting for resuscitation practices across hospital groups (adjusted odds ratio [OR], 3.90; 95% CI, 1.39–10.95). In contrast, there was no difference in survival between sites without very active champions and those with very active non‐physician champions (adjusted OR, 1.28; 95% CI, 0.62–2.65). Conclusions The background and engagement level of a resuscitation champion is a critical factor in a hospital's survival outcomes for IHCA.

Abstract 181: Patterns of Waveform and Energy Use in Defibrillation for Cardiac Arrest: Insights from the Get With The Guidelines-Resuscitation Registry

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Preston M Schneider ◽  
Wenhui Liu ◽  
Gary K Grunwald ◽  
Paul S Chan ◽  
Brahmajee K Nallamothu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Energy Use ◽  
National Registry ◽  
Study Cohort ◽  
Chi Square ◽  
Frequent Use ◽  
Biphasic Waveform ◽  
Chi Square Test ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Early defibrillation for termination of life-threatening arrhythmias is key to survival of cardiac arrest. Biphasic waveform defibrillation has been suggested as superior to monophasic waveform defibrillation, but little is known about trends in defibrillation waveform and energy used for in-hospital cardiac arrest. Methods: Within Get With The Guidelines-Resuscitation, a national registry of in-hospital cardiac arrest, we identified subjects over age 18 with an in-hospital cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia between 2005 and 2012. We restricted the study cohort to this time period, as defibrillation waveform and energy were not captured prior to 2005. We examined calendar year trends in defibrillation waveform and energy of first defibrillation attempt using the chi-square test. Results: A total of 22,108 patients from 504 facilities were identified. In 2005, in which there were 2898 in-hospital cardiac arrest cases, 1911 (66%) events were treated with biphasic defibrillation and 987 (34%) with monophasic defibrillation. By 2012, nearly all (97% [1460/1502]) events were treated with biphasic defibrillation; p for trend < 0.0001 (see Figure). For biphasic defibrillation, the predominant energy used for first defibrillation attempt was 200 J (55.91% of events) with 150 J being the next most common (18.21% of events) with a trend toward more frequent use of 200 J (p < 0.0001). Conclusion: Biphasic defibrillation at 200 J is now the predominant waveform and energy used for initial defibrillation during in-hospital cardiac arrest. Additional work is needed to determine if a rise in use of biphasic defibrillation is improving outcomes.

Abstract 207: The Prevalence and Significance of Abnormal Vital Signs Prior to In-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Won Young Kim ◽  
Lars W Andersen ◽  
Sharri Mortensen ◽  
Maureen Chase ◽  
Katherine Berg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Vital Sign ◽  
Multivariable Analysis ◽  
Vital Signs ◽  
National Registry ◽  
Patient Demographics ◽  
Get With The Guidelines ◽  
Hospital Wards ◽  
Hospital Cardiac Arrest ◽  
Overall Mortality

Background: The association between vital sign abnormalities prior to cardiac arrest and outcome has not been previously reported. In this study we investigated the prevalence of abnormal vital signs prior to in-hospital cardiac arrest and the association with mortality Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between 2007-2010. We included index events and excluded patients with missing data on vital signs within 1-4 hours prior to arrest. We evaluated the prevalence of abnormal vital signs classified as mild, moderate or severe (Table 1). We determined the association between the number of abnormal vital signs per patient and in-hospital mortality using multivariate logistic regression with adjustment for multiple potential confounders including patient demographics and co-morbid conditions. Results: A total of 9,560 patients were included. Median age was 71 (60 - 81) years, 42% were female and overall mortality was 77%. The prevalence of vital sign abnormalities is shown in Table 1. As illustrated in Figure 1 we found a step-wise increase in mortality with increasing number of abnormal vital signs that remained in multivariable analysis across all categories (Mild: adjusted OR 1.37 [CI: 1.27 - 1.48], Moderate: adjusted OR 1.53 [CI: 1.35 - 1.73] and Severe: adjusted OR 1.43 [CI: 1.21 - 1.70], all p-values < 0.0001). Conclusion: Abnormal vital signs are common within four hours before cardiac arrest on in-hospital wards. Our study demonstrates incremental increases in mortality with both increasing number of pre-arrest abnormal vital signs as well as increased severity.

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