In-hospital cardiac arrests
From Standard of Care
Approximately 200,000 events annually.
Unexpected events that are difficult to predict with certainty.
Involves heterogeneous patients.
Mananaged by a variety of of specilaties, hospital sites, allied personnel to provide resuscitation efforts.
Survival after IHCA has improved over the last decade.
Lowered survival associated with delay in defibrillation, unwitnessed events, after hour events, and black race.
Variation in survival across hospitals.
Delay in treatment associated with lower survival rate and worse neurological outcomes (Chan).
Many patient who experience such events have physiologic deterioration hours before the event (Hillman).
In a study of hospitalized Medicare patients undergoing cardiopulmonary resuscitation from 1992-2005 there was no significant change in survival to discharge (Ehlenbach WJ et al).
Among 84,625 hospitalized patients with cardiac arrest 79.3% with initial asystole or pulseless electrical activity and 20.7% with ventricular fibrillation or pulseless ventricular tachycardia: risk adjusted survival rates to discharge increased from 13.7% in 2000 to 22.3% in 2009 due to improved acute resuscitation survival and post resuscitation survival Get with the Guidelines -Resuscitation Investigators).
In the above study significant neurologic disability among survivors decreased over time from an adjusted rate of 32.9% in 2000 and 28.1% in 2009.
