Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;112(2):258-269.
doi: 10.1007/s00392-022-02084-1. Epub 2022 Aug 17.

Clinical characteristics, causes and predictors of outcomes in patients with in-hospital cardiac arrest: results from the SURVIVE-ARREST study

Laura Erika Maria Hannen #  1 , Betül Toprak #  1   2 , Jessica Weimann  1 , Bahara Mahmoodi  1 , Nina Fluschnik  1 , Benedikt Schrage  1   2 , Kevin Roedl  3 , Gerold Söffker  3 , Stefan Kluge  3 , Malte Issleib  4 , Stefan Blankenberg  1   2 , Paulus Kirchhof  1   2   5 , Peter Clemmensen  1   2   6 , Christoph Sinning  1   2   7 , Elvin Zengin-Sahm #  1   7 , Peter Moritz Becher #  8   9
Affiliations

Clinical characteristics, causes and predictors of outcomes in patients with in-hospital cardiac arrest: results from the SURVIVE-ARREST study

Laura Erika Maria Hannen et al. Clin Res Cardiol. 2023 Feb.

Abstract

Introduction: In-hospital cardiac arrest (IHCA) is acutely life-threatening and remains associated with high mortality and morbidity. Identifying predictors of mortality after IHCA would help to guide acute therapy.

Methods: We determined patient characteristics and independent predictors of 30-day in-hospital mortality, neurological outcome, and discharge/referral pathways in patients experiencing IHCA in a large tertiary care hospital between January 2014 and April 2017. Multivariable Cox regression model was fitted to assess predictors of outcomes.

Results: A total of 368 patients with IHCA were analysed (median age 73 years (interquartile range 65-78), 123 (33.4%) women). Most patients (45.9%) had an initial non-shockable rhythm and shockable rhythms were found in 20.9%; 23.6% of patients suffered from a recurrent episode of cardiac arrest. 172/368 patients died within 30 days (46.7%). Of 196/368 patients discharged alive after IHCA, the majority (72.9%, n = 143) had a good functional neurological outcome (modified Rankin Scale ≤ 3 points). In the multivariable analysis, return of spontaneous circulation without mechanical circulatory support (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.21-0.64), invasive coronary angiography and/or percutaneous intervention (HR 0.56, 95% CI 0.34-0.92), and antibiotic therapy (HR 0.87, 95% CI 0.83-0.92) were associated with a lower risk of 30-day in hospital mortality.

Conclusion: In the present study, IHCA was survived in ~ 50% in a tertiary care hospital, although only a minority of patients presented with shockable rhythms. The majority of IHCA survivors (~ 70%) had a good neurological outcome. Recovery of spontaneous circulation and presence of treatable acute causes of the arrest are associated with better survival. Clinical Characteristics, Causes and Predictors of Outcomes in Patients with In-Hospital Cardiac Arrest: Results from the SURVIVE-ARREST Study.

Abbreviations: CPR, cardiopulmonary resuscitation; IHCA, In-hospital cardiac arrest; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; SBP, systolic blood pressure.

Keywords: Hospitalization; In-hospital cardiac arrest; Mortality; Outcomes; Survival.

PubMed Disclaimer

Conflict of interest statement

Dr. Becher was partially supported by the German Research Foundation (Grant number BE 7424/2-1). Dr. Schrage received funding from the German Research Foundation and the Else Kröner-Fresenius-Stiftung, and speakers fees from Astra Zeneca, outside from the submitted work. Dr. Toprak receives funding for a research project by the German Foundation of Heart Research outside the submitted work. Dr. Kluge received research support from Cytosorbents and Daiichi Sankyo. He also received lecture fees from Astra, Bard, Baxter, Biotest, Cytosorbents, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Philips and Zoll. He received consultant fees from Fresenius, Gilead, MSD and Pfizer. Dr. Blankenberg reports grants from Abbott Diagnostics, Siemens, Singulex, grants and personal fees from Bayer, Thermofisher, personal fees from Novartis, outside the submitted work; and payments or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events, support for attending meetings and travel from Abbott, AstraZeneca, Bayer, Amgen, Medtronic, Pfizer, Siemens and Thermofisher, all outside the submitted work. Dr. Kirchhof was partially supported by European Union BigData@Heart (grant agreement EU IMI 116074), AFFECT-AF (grant agreement 847770), and MAESTRIA (grant agreement 965286), British Heart Foundation (AA/18/2/34218), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK), and Leducq Foundation. PK receives research support for basic, translational, and clinical research projects from European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Cardiovascular Research, from several drug and device companies active in atrial fibrillation and has received honoraria from several such companies in the past, but not in the last three years. PK is listed as inventor on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). Dr. Clemmensen reports personal fees from Abbott, Acarix, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Evolva, Fibrex, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Regado, Sanofi, Searle, and Servier, all outside the submitted work. Dr. Sinning received fees from AstraZeneca and Johnson&Johnson, all outside the submitted work. Dr. Zengin-Sahm received fees from AstraZeneca, all outside the submitted work. Dr. Hannen, Dr. Fluschnik, Dr. Issleib, Dr. Roedl, Dr. Söffker, Mrs. Mahmoodi, Mrs. Weimann have no COI to declare.

Figures

Fig. 1
Fig. 1
Independent predictors associated with 30-day in-hospital mortality. Afib atrial fibrillation, AS aortic stenosis, AVB atrioventricular block, bpm beats per minute, CI confidence interval, CPR C-reactive protein, ECG electrocardiogram, ECMO extracorporeal membrane oxygenation, HR hazard ratio, hsTnT high sensitivity troponin T, ICU intensive care unit, LBBB left bundle branch block, MAP mean arterial pressure, MCS mechanical circulatory support, NT-proBNP N-terminal-pro-brain-natriuretic peptide, PEA pulseless electrical activity, pH potential of hydrogen, RBBB right bundle branch block, ROSC return of spontaneous circulation, SBP systolic blood pressure, SD standard deviation
Fig. 2
Fig. 2
Multivariable predictors of 30-day in-hospital mortality. CI confidence interval, CPR cardiopulmonary resuscitation, HR hazard ratio, MCS mechanical circulatory support, PCI percutaneous coronary intervention, ROSC return of spontaneous circulation, SBP systolic blood pressure
Fig. 3
Fig. 3
Cumulative incidence of 30-day mortality in the overall cohort and stratified by age and initial rhythm after IHCA. PEA pulseless electrical activity, VF Ventricular fibrillation, VT Ventricular tachycardia
Fig. 4
Fig. 4
Functional neurological outcome at discharge (A) and discharge and referral pathways (B) in patients post IHCA. mRS modified Rankin Scale
See this image and copyright information in PMC

References

    1. Sandroni C, et al. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(2):237–245. doi: 10.1007/s00134-006-0326-z. - DOI - PubMed
    1. Hirlekar G, et al. Survival and neurological outcome in the elderly after in-hospital cardiac arrest. Resuscitation. 2017;118:101–106. doi: 10.1016/j.resuscitation.2017.07.013. - DOI - PubMed
    1. Rohlin O, et al. Duration of CPR and impact on 30-day survival after ROSC for in-hospital cardiac arrest-A Swedish cohort study. Resuscitation. 2018;132:1–5. doi: 10.1016/j.resuscitation.2018.08.017. - DOI - PubMed
    1. Schluep M, et al. One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2018;132:90–100. doi: 10.1016/j.resuscitation.2018.09.001. - DOI - PubMed
    1. Chan PS, Tang Y, American Heart Association's Get With the Guidelines-Resuscitation I Risk-standardizing rates of return of spontaneous circulation for in-hospital cardiac arrest to facilitate hospital comparisons. J Am Heart Assoc. 2020;9(7):e014837. doi: 10.1161/JAHA.119.014837. - DOI - PMC - PubMed