In-hospital cardiac arrest: the state of the art

Abstract

In-hospital cardiac arrest (IHCA) is associated with a high risk of death, but mortality rates are decreasing. The latest epidemiological and outcome data from several cardiac arrest registries are helping to shape our understanding of IHCA. The introduction of rapid response teams has been associated with a downward trend in hospital mortality. Technology and access to defibrillators continues to progress. The optimal method of airway management during IHCA remains uncertain, but there is a trend for decreasing use of tracheal intubation and increased use of supraglottic airway devices. The first randomised clinical trial of airway management during IHCA is ongoing in the UK. Retrospective and observational studies have shown that several pre-arrest factors are strongly associated with outcome after IHCA, but the risk of bias in such studies makes prognostication of individual cases potentially unreliable. Shared decision making and advanced care planning will increase application of appropriate DNACPR decisions and decrease rates of resuscitation attempts following IHCA.

Keywords: Cardiac arrest; Prognostication; Response; Resuscitation; Treatment.

Fig. 1

Causes of in-hospital cardiac arrest derived from a large systematic review and meta-analysis [13]. Cause with associated 95% confidence intervals: hypoxia (14.2%–38.7%), neurological causes (1–3.4%), acute coronary syndrome (13.9–22.6%), toxins (0.2–1.6%), pneumothorax (0.06–0.14%), arrhythmias (0–34.9%), hypovolaemia (7.0– 22.7%), infection (9.5–19.3%), heart failure (6.5–18.8%), unknown (5.1–23.2%), electrolyte disturbances (0.9–5.1%), cardiac tamponade (0.3–5.7%), pulmonary embolism (2.2–3.1%)