Multicenter Study

. 2023 Feb:183:109664.

doi: 10.1016/j.resuscitation.2022.12.002. Epub 2022 Dec 12.

Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

Anthony P Carnicelli¹, Ryan Keane², Kelly M Brown³, Daniel B Loriaux³, Payton Kendsersky⁴, Carlos L Alviar⁵, Kelly Arps³, David D Berg⁶, Erin A Bohula⁶, James A Burke⁷, Jeffrey A Dixson³, Daniel A Gerber⁸, Michael Goldfarb⁹, Christopher B Granger³, Jianping Guo⁶, Robert W Harrison³, Michael Kontos¹⁰, Patrick R Lawler¹¹, P Elliott Miller¹², Jose Nativi-Nicolau¹³, L Kristin Newby³, Lekha Racharla⁷, Robert O Roswell¹⁴, Kevin S Shah¹⁵, Shashank S Sinha¹⁶, Michael A Solomon¹⁷, Jeffrey Teuteberg⁸, Graham Wong¹⁸, Sean van Diepen¹⁹, Jason N Katz³, David A Morrow⁶

Affiliations

¹ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: carnicel@musc.edu.
² Division of Cardiology, Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
³ Duke University Hospital, Division of Cardiology, Durham, NC, USA.
⁴ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
⁵ Leon H Charney Division of Cardiology, Bellevue Hospital Center, New York University School of Medicine, New York, NY, USA.
⁶ TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Lehigh Valley Heart Institute, Allentown, PA, USA.
⁸ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹⁰ Division of Cardiology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
¹¹ Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
¹² Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
¹³ Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁴ Lennox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁵ Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁶ Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA.
¹⁷ Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD, USA.
¹⁸ Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Alberta, Canada.

PMID: 36521683
PMCID: PMC9899313
DOI: 10.1016/j.resuscitation.2022.12.002

Multicenter Study

Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

Anthony P Carnicelli et al. Resuscitation. 2023 Feb.

. 2023 Feb:183:109664.

doi: 10.1016/j.resuscitation.2022.12.002. Epub 2022 Dec 12.

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: carnicel@musc.edu.
² Division of Cardiology, Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
³ Duke University Hospital, Division of Cardiology, Durham, NC, USA.
⁴ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
⁵ Leon H Charney Division of Cardiology, Bellevue Hospital Center, New York University School of Medicine, New York, NY, USA.
⁶ TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Lehigh Valley Heart Institute, Allentown, PA, USA.
⁸ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹⁰ Division of Cardiology, Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
¹¹ Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
¹² Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
¹³ Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁴ Lennox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁵ Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁶ Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA.
¹⁷ Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD, USA.
¹⁸ Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Alberta, Canada.

PMID: 36521683
PMCID: PMC9899313
DOI: 10.1016/j.resuscitation.2022.12.002

Abstract

Background: Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA.

Methods: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA.

Results: We analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p < 0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p < 0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p < 0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p < 0.001) and in-hospital mortality (36.1% vs 44.1%, p < 0.001).

Conclusion: Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.

Keywords: CICU; Cardiac arrest; IHCA; OHCA; TTM; cardiac critical care; cardiac intensive care unit; in-hospital cardiac arrest; out-of-hospital cardiac arrest; targeted temperature management.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Figure 1:. Key CICU admission characteristics for patients with cardiac arrest.**
CICU = cardiac intensive care unit; IHCA = in-hospital cardiac arrest; OHCA = out-of-hospital cardiac arrest

**Figure 2:. CICU resource utilization among patients with cardiac arrest.**
CICU = cardiac intensive care unit; IHCA = in-hospital cardiac arrest; OHCA = out-of-hospital cardiac arrest; PCI = percutaneous coronary intervention

**Figure 3:. Outcomes of patients presenting to the CICU after cardiac arrest**
Crude rates are presented. Discharge disposition data missing in n=11 patients. *In-hospital deaths are inclusive of CICU deaths; Possible outcomes include death, discharge home/rehab, inpatient facility (not shown), or hospice (not shown). For n=496 with OHCA who were discharge home or to rehab, n=379 were discharged home and n=117 were discharged to rehab. For n=558 with IHCA who were discharge home or to rehab, n=415 were discharged home and n=143 were discharged to rehab. CICU = cardiac intensive care unit; IHCA = in-hospital-cardiac arrest; OHCA = out-hospital-cardiac arrest

**Figure 4:. In-Hospital Mortality by OHCA and IHCA**
OHCA = out-hospital-cardiac arrest; IHCA = in-hospital-cardiac arrest

See this image and copyright information in PMC

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Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

Affiliations

Characteristics, therapies, and outcomes of In-Hospital vs Out-of-Hospital cardiac arrest in patients presenting to cardiac intensive care units: From the critical care Cardiology trials network (CCCTN)

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Conflict of interest statement

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