The epidemiology of in-hospital cardiac arrests in Australia: a prospective multicentre observational study

Abstract

Background: Australian in-hospital cardiac arrest (IHCA) literature is limited, and mostly published before rapid response teams (RRTs). Contemporary data may inform strategies to improve IHCA outcomes.

Study design: Prospective observational study of ward adult IHCAs in seven Australian hospitals.

Participants and outcomes: IHCA was defined as unresponsiveness, no respiratory effort, and commencement of external cardiac compressions. Data included IHCA frequency, patient demographics, resuscitation management, intensive care unit (ICU) management, and hospital discharge status.

Results: There were 15 953 RRT calls, 185 896 multiday admissions and 159 IHCAs in 152 patients (median age, 71.5 years; interquartile range [IQR], 61.6-81.3 years). The median IHCA frequency was 0.62 IHCAs per 1000 multiday admissions (IQR, 0.50-1.19). Most patients (93.4%) were admitted from home, and 68.4% (104/152) were medical admissions. Eighty-two IHCAs (51.6%) occurred within 4 days of admission, and 66.0% (105/159) of initial rhythms were non-shockable. The median resuscitation duration was 6.5 minutes (IQR, 2.0-18.0 minutes) and adrenaline was the most common intervention (95/159; 59.8%). Death on the ward occurred in 30.2% of IHCAs (48/159), and 49.7% (79/159) were admitted to the ICU, where vasoactive medications (75.9%), ventilation (82.3%), and renal replacement therapy (29.1%) use was extensive. Overall, 92 patients (60.5%) died and 40 (26.3%) were discharged home.

Conclusion: Among seven Australian hospitals, IHCAs were infrequent, mostly occurred in older medical patients early in the hospital admission. Most were non-shockable, ICU therapy was extensive and nearly two-thirds of patients died in hospital. Further strategies are needed to prevent and improve ICHA outcomes.