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Observational Study
. 2019 Jul 9;12(7):e005580.

Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States

Mathias J. Holmberg  1   2 , Catherine E. Ross  3 , Garrett M. Fitzmaurice  4   5   6 , Paul S. Chan  7 , Jordan Duval-Arnould  8 , Anne V. Grossestreuer  2 , Tuyen Yankama  2 , Michael W. Donnino  2   9 , Lars W. Andersen  1   2 ; American Heart Association’s Get With The Guidelines–Resuscitation Investigators
Affiliations
Observational Study

Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States

Mathias J. Holmberg et al. Circ Cardiovasc Qual Outcomes. .

Abstract

Background: Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized adult and pediatric patients across the United States. The aim of this study was to estimate the contemporary annual incidence of in-hospital cardiac arrest in adults and children across the United States and to describe trends in incidence between 2008 and 2017.

Methods and results: Using the Get With The Guidelines– Resuscitation registry, we developed a negative binomial regression model to estimate the incidence of index pulseless in-hospital cardiac arrest based on hospital-level characteristics. The model was used to predict the number of in-hospital cardiac arrests in all US hospitals, using data from the American Hospital Association Annual Survey. We performed separate analyses for adult (≥18 years) and pediatric (<18 years) cardiac arrests. Additional analyses were performed for recurrent cardiac arrests and pediatric patients requiring cardiopulmonary resuscitation for poor perfusion (nonpulseless events). The average annual incidence of in-hospital cardiac arrest in the United States was estimated at 292 000 (95% prediction interval, 217 600–503 500) adult and 15 200 pediatric cases, of which 7100 (95% prediction interval, 4400–9900) cases were pulseless cardiac arrests and 8100 (95% prediction interval, 4700–11 500) cases were nonpulseless events. The rate of adult cardiac arrests increased over time, while pediatric events remained more stable. When including both index and recurrent inhospital cardiac arrests, the average annual incidence was estimated at 357 900 (95% prediction interval, 247 100–598 400) adult and 19 900 pediatric cases, of which 8300 (95% prediction interval, 4900–11 200) cases were pulseless cardiac arrests and 11 600 (95% prediction interval, 6400–16 700) cases were nonpulseless events.

Conclusions: There are ≈292 000 adult in-hospital cardiac arrests and 15 200 pediatric in-hospital events in the United States each year. This study provides contemporary estimates of the public health burden of cardiac arrest among hospitalized patients.

Keywords: epidemiology; heart arrest; hospitals; incidence.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.. Annual trends in the incidence of adult in-hospital cardiac arrest in the United States.
The average number of index cardiac arrests occurring in hospitalized adult patients between 2008 and 2017 was estimated at 292,000 (95% prediction interval: 217,600, 503,500) cases per year. There was an increase in cardiac arrests over time (incidence rate ratio: 1.03, 95%CI: 1.02, 1.03). Numerical estimates are provided in Table S4.
Figure 2.
Figure 2.. Annual trends in the incidence of pediatric pulseless in-hospital cardiac arrest in the United States.
The average number of index pulseless cardiac arrests occurring in hospitalized pediatric patients between 2008 and 2017 was estimated at 7,100 (95% prediction interval: 4,400, 9,900) cases per year. There was no clear change in incidences over time (incidence rate ratio: 0.97, 95%CI: 0.94, 1.00), p = 0.08). Numerical estimates are provided in Table S9.
Figure 3.
Figure 3.. Annual trends in the incidence of pediatric non-pulseless events in the United States.
The average number of index non-pulseless events requiring cardiopulmonary resuscitation in hospitalized pediatric patients between 2008 and 2017 was estimated at 8,100 (95% prediction interval: 4,700, 11,500) cases per year. There was no clear difference in incidences over time (incidence rate ratio: 1.00, 95%CI: 0.97, 1.04), p = 0.09). Numerical estimates are provided in Table S12.
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