Comparison of two strategies for managing in-hospital cardiac arrest

Abstract

In-hospital cardiac arrest (IHCA) is associated with poor outcomes. There are currently no standards for cardiac arrest teams in terms of member composition and task allocation. Here we aimed to compare two different cardiac arrest team concepts to cover IHCA management in terms of survival and neurological outcomes. This prospective study enrolled 412 patients with IHCA from general medical wards. From May 2014 to April 2016, 228 patients were directly transferred to the intensive care unit (ICU) for ongoing resuscitation. In the ICU, resuscitation was extended to advanced cardiac life support (ACLS) (Load-and-Go [LaG] group). By May 2016, a dedicated cardiac arrest team provided by the ICU provided ACLS in the ward. After return of spontaneous circulation (ROSC), the patients (n = 184) were transferred to the ICU (Stay-and-Treat [SaT] group). Overall, baseline characteristics, aetiologies, and characteristics of cardiac arrest were similar between groups. The time to endotracheal intubation was longer in the LaG group than in the SaT group (6 [5, 8] min versus 4 [2, 5] min, p = 0.001). In the LaG group, 96% of the patients were transferred to the ICU regardless of ROSC achievement. In the SaT group, 83% of patients were transferred to the ICU (p = 0.001). Survival to discharge did not differ between the LaG (33%) and the SaT (35%) groups (p = 0.758). Ultimately, 22% of patients in the LaG group versus 21% in the SaT group were discharged with good neurological outcomes (p = 0.857). In conclusion, we demonstrated that the cardiac arrest team concepts for the management of IHCA did not differ in terms of survival and neurological outcomes. However, a dedicated (intensive care) cardiac arrest team could take some load off the ICU.

Figure 1

Cardiac arrest team concepts for the management of IHCA. (A) From May 2014 to April 2016, IHCA patients were supplied by a Load-and-Go (LaG) concept. From May 2016 to April 2018, the ICU provided a cardiac arrest team that managed IHCA using a Stay-and-Treat (SaT) concept. (B) Outcome of IHCA was determined by the setting at which IHCA occurred, time delay until detection and IHCA call was performed, and possibly by the characteristics of the IHCA team concept (focus of the present study). IHCA In-hospital cardiac arrest, CPR cardiopulmonary resuscitation, ICU Intensive Care unit, ACLS Advanced cardiac life support.

Figure 2

Outcome after IHCA. (A) Survival was similar between the two different cardiac arrest team concepts, the Load-and-Go group and the Stay-and-Treat group. (B) Neurological outcome was determined at the time of discharge according to the Cerebral Performance Category (CPC) scale after IHCA. CPC scale of 1 and 2 indicates good neurological outcome. Neurological outcome was similar between the two different cardiac arrest team concepts, the Load-and-Go and the Stay-and-Treat groups. IHCA in-hospital cardiac arrest, CPC cerebral performance category.