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. 2018 Jan 30;71(4):402-411.
doi: 10.1016/j.jacc.2017.11.043.

Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

Uchenna R Ofoma  1 , Suresh Basnet  2 , Andrea Berger  3 , H Lester Kirchner  3 , Saket Girotra  4 ; American Heart Association Get With the Guidelines – Resuscitation Investigators
Collaborators, Affiliations

Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

Uchenna R Ofoma et al. J Am Coll Cardiol. .

Abstract

Background: Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed.

Objectives: This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA.

Methods: We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines-Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7:00 am to 10:59 pm) versus off-hours (Monday to Friday 11:00 pm to 6:59 am, and Saturday to Sunday, all day).

Results: Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p < 0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend < 0.001 for both), the absolute and relative difference persisted.

Conclusions: Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists.

Keywords: cardiac arrest; cardiopulmonary resuscitation; outcome; patient safety; return of spontaneous circulation.

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Conflict of interest statement

Disclosures: All authors have declared no conflict of interest

Figures

Figure 1
Figure 1. Study Flow Chart
The flowchart illustrates derivation of the study cohort.
Figure 2
Figure 2. Cardiac Arrest Survival Flow Chart
The flowchart illustrates survival during acute resuscitation for cardiac arrest and survival to hospital discharge among study cohort
Figure 3
Figure 3. Trends in Acute Resuscitation Survival and Post-Resuscitation Survival Stratified by timing of IHCA
The graph shows unadjusted A) acute resuscitation survival and B) post-resuscitation survival in patients who arrested during on-hours (solid line) and off-hours (dashed line).
Central Illustration
Central Illustration. Trends in Survival to Discharge Stratified by Timing of IHCA
The graph shows unadjusted survival to discharge by calendar year in patients who arrested during on-hours (solid line) and off-hours (dashed line).
See this image and copyright information in PMC

Comment in

References

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