Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN). (February 2023)

• Record Type: Journal Article
• Authors: Carnicelli, Anthony P; Keane, Ryan; Brown, Kelly M; Loriaux, Daniel B; Kendsersky, Payton; Alviar, Carlos L; Arps, Kelly; Berg, David D; Bohula, Erin A; Burke, James A; Dixson, Jeffrey A; Gerber, Daniel A; Goldfarb, Michael; Granger, Christopher B; Guo, Jianping; Harrison, Robert W; Kontos, Michael; Lawler, Patrick R; Miller, P Elliott; Nativi-Nicolau, Jose; Newby, L Kristin; Racharla, Lekha; Roswell, Robert O; Shah, Kevin S; Sinha, Shashank S; Solomon, Michael A; Teuteberg, Jeffrey; Wong, Graham; van Diepen, Sean; Katz, Jason N; Morrow, David A;
• Is Part Of: Resuscitation. Volume 183(2023)
• Publication Date: 2023-02
• Subjects: Cardiac arrest -- out-of-hospital cardiac arrest -- in-hospital cardiac arrest -- cardiac intensive care unit -- CICU -- OHCA -- IHCA cardiac critical care targeted temperature management TTM; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2022.12.002
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA. Methods: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA. Results: We analyzed 2, 075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p < 0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p < 0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p < 0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p < 0.001) and in-hospital mortality (36.1% vs 44.1%, p < 0.001). Conclusion: Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.