Comparison of two strategies for managing in-hospital cardiac arrest

In-hospital cardiac arrest (IHCA) is associated with poor outcomes. There are currently no standards for cardiac arrest teams in terms of member composition and task allocation. Here we aimed to compare two different cardiac arrest team concepts to cover IHCA management in terms of survival and neurological outcomes. This prospective study enrolled 412 patients with IHCA from general medical wards. From May 2014 to April 2016, 228 patients were directly transferred to the intensive care unit (ICU) for ongoing resuscitation. In the ICU, resuscitation was extended to advanced cardiac life support (ACLS) (Load-and-Go [LaG] group). By May 2016, a dedicated cardiac arrest team provided by the ICU provided ACLS in the ward. After return of spontaneous circulation (ROSC), the patients (n = 184) were transferred to the ICU (Stay-and-Treat [SaT] group). Overall, baseline characteristics, aetiologies, and characteristics of cardiac arrest were similar between groups. The time to endotracheal intubation was longer in the LaG group than in the SaT group (6 [5, 8] min versus 4 [2, 5] min, p = 0.001). In the LaG group, 96% of the patients were transferred to the ICU regardless of ROSC achievement. In the SaT group, 83% of patients were transferred to the ICU (p = 0.001). Survival to discharge did not differ between the LaG (33%) and the SaT (35%) groups (p = 0.758). Ultimately, 22% of patients in the LaG group versus 21% in the SaT group were discharged with good neurological outcomes (p = 0.857). In conclusion, we demonstrated that the cardiac arrest team concepts for the management of IHCA did not differ in terms of survival and neurological outcomes. However, a dedicated (intensive care) cardiac arrest team could take some load off the ICU.

Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study

Background Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21–30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests. Methods We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey. Results The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status. Conclusions The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system. Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

Survival and Long-term Outcomes Following in-hospital Cardiac Arrest in a Swiss University Hospital: a Prospective Observational Study

Background: Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team from the Department of Anaesthesiology and Pain Medicine that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests are unknown. The aim was thus to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.Methods: We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days and 1 year), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.Results: The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ±13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived to 1 year after the event showed favourable neurological and functional status. Conclusions: The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1,000 patient admissions. After a cardiac arrest, about a third of the patients survived to 1 year with favourable neurological and functional status. Early recognition and high-quality cardiopulmonary resuscitation provided by a well-organised team is crucial for patient survival.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

Should critical care doctors be part of the cardiac arrest call team?

The composition of the cardiac arrest team varies widely both throughout the UK and the world. There are no agreed standards regarding the composition of the resuscitation team, and variety in teams is often dictated by availability of staff and financial constraints. This article discusses the evidence for and against the inclusion of critical care doctors on the cardiac arrest call team.

Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

Abstract 177: Resuscitation Team Challenges During In-Hospital Cardiac Arrest: A Prospective Multicenter Study

Introduction: Measured quality of CPR is often substandard compared to guideline recommendations during adult in-hospital cardiac arrest. Aim: To investigate the self-perceived CPR quality, teamwork and communication and to identify the most frequently reported challenges experienced during in-hospital cardiac arrest. Methods: Prospective multicenter study including self-reported data from resuscitation attempts treated by cardiac arrest teams in 5 Danish hospitals (1 university hospital, 4 regional hospitals). Data from October 2016 to May 2018 was included. Following each resuscitation attempt, all cardiac arrest team members were questioned by an online questionnaire, specifically on perceived CPR quality, teamwork and communication on a Likert scale. In addition, challenges experienced during the resuscitation attempt were inquired. Results: Of 491 cardiac arrests, the cardiac arrest team was actively involved in 387 cases (79%). Of 2,271 questionnaires there were 1,639 responses (response rate: 72%). Overall, 87% agreed or partially agreed that the CPR quality was optimal, 89% agreed or partially agreed that the teamwork was optimal, and 88% agreed or partially agreed that the communication was optimal. The most frequently reported challenges experienced were: too many health care providers present in the room (26%), healthcare providers poorly placed relative to each other in the room during resuscitation (16%), lacking space for resuscitation equipment (16%), problems finding resuscitation equipment (14%), problems finding the location of cardiac arrest (5%), and other challenges (10%). Challenges with too many healthcare providers in the room were associated with the total amount of persons in the room (p<0.001), amount of non-team members present (P<0.001) but not the number of members on the cardiac arrest team (p=0.70). Conclusions: During in-hospital resuscitation, most cardiac arrest team members perceive that CPR quality, teamwork, and communication are optimal. However, Challenges during resuscitation are not uncommon and include overcrowding, lack of space and problems locating resuscitation equipment.