Temporal variation in survival following in-hospital cardiac arrest in Sweden. (15th June 2023)

• Record Type: Journal Article
• Authors: Hessulf, Fredrik; Herlitz, Johan; Lundgren, Peter; Aune, Solveig; Myredal, Anna; Engdahl, Johan; Rawshani, Araz
• Is Part Of: International journal of cardiology. Volume 381(2023)
• Page Start: 112
• Page End: 119
• Publication Date: 2023-06-15
• Subjects: In-hospital cardiac arrest -- Cardiopulmonary resuscitation -- Time -- Equality; CA Cardiac arrest -- CPR Cardiopulmonary resuscitation -- IHCA In-hospital cardiac arrest -- ROSC Return of spontaneous circulation -- VF/pVT Ventricular fibrillation/pulseless ventricular tachycardia -- PEA Pulseless electrical activity -- SRC Swedish Resuscitation Council -- CAT Cardiac arrest team -- ICU/CCU Intensive care unit/coronary care unit -- AED Automated external defibrillator -- OR Odds ratio; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.03.069
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The aim of the study was to investigate what characterizes IHCAs that take place during the "day" (Monday-Friday 7 am-3 pm), "evening" (Monday-Friday 3 pm–9 pm) and "night" (Monday-Friday 9 pm-7 am and Saturday-Sunday 12 am- 11.59 pm). Methods: We used the Swedish Registry for CPR (SRCR) to study 26, 595 patients from January 1, 2008 to December 31, 2019. Adult patients ≥18 years with a IHCA where resuscitation was initiated were included. Uni- and multivariable logistic regression was used to investigate associations between temporal factors and survival to 30 days. Results: 30-day survival and Return of Spontaneous Circulation (ROSC) was 36.8% and 67.9% following CA during the day and decreased during the evening (32.0% and 66.3%) and night (26.2% and 60.2%) ( p < 0.001 and p = 0.028). When comparing the survival rates between the day and the night, survival decreased more (change in relative survival rates) in small (<99 beds) compared to large (<400) hospitals (35.9% vs 25%), in non-academic vs academic hospitals (33.5% vs 22%) and on non-Electro Cardiogram (ECG)-monitored wards vs ECG-monitored wards (46.2% vs 20.9%) (p < 0.001 for all). IHCAs that took place during the day (adjusted Odds Ratio (aOR) 1.47 95% CI 1.35–1.60), in academic hospitals (aOR 1.14 95% CI 1.02–1.27) and in large (>400 beds) hospitals (aOR 1.31 95% CI 1.10–1.55) were independently associated with an increased chance of survival. Conclusions: Patients suffering an IHCA have an increased chance of survival during the day vs the evening vs night, and the difference in survival is even more pronounced when cared for at smaller, non-academic hospitals, general wards and wards without ECG-monitoring capacity. Highlights: 30-day survival and rates of ROSC following in-hospital cardiac arrest were highest during the day (36.8% and 67.9%) and decreased during the evening (32.0% and 66.3%) and night (26.2% and 60.2%) Relatively greater decreases in survival from day to evening to night were associated with IHCAs in small hospitals, non-academic hospitals and on non-ECG-monitored wards The difference in survival raises the question whether IHCA care is truly equal.