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
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 Carnicelli  1 , Ryan Keane  2 , Kelly M Brown  3 , Daniel B Loriaux  3 , Payton Kendsersky  4 , Carlos L Alviar  5 , Kelly Arps  3 , David D Berg  6 , Erin A Bohula  6 , James A Burke  7 , Jeffrey A Dixson  3 , Daniel A Gerber  8 , Michael Goldfarb  9 , Christopher B Granger  3 , Jianping Guo  6 , Robert W Harrison  3 , Michael Kontos  10 , Patrick R Lawler  11 , P Elliott Miller  12 , Jose Nativi-Nicolau  13 , L Kristin Newby  3 , Lekha Racharla  7 , Robert O Roswell  14 , Kevin S Shah  15 , Shashank S Sinha  16 , Michael A Solomon  17 , Jeffrey Teuteberg  8 , Graham Wong  18 , Sean van Diepen  19 , Jason N Katz  3 , David A Morrow  6
Affiliations
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.

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.

PubMed Disclaimer

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:
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:
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:
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:
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

References

    1. Miller PE, Chouairi F, Thomas A, Kunitomo Y, Aslam F, Canavan ME, et al. Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes. J Am Heart Assoc. 2021;10:e018182. - PMC - PubMed
    1. Bohula EA, Katz JN, van Diepen S, Alviar CL, Baird-Zars VM, Park JG, et al. Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness. JAMA Cardiol. 2019;4:928–35. - PMC - PubMed
    1. Fugate JE, Brinjikji W, Mandrekar JN, Cloft HJ, White RD, Wijdicks EF, et al. Post-cardiac arrest mortality is declining: a study of the US National Inpatient Sample 2001 to 2009. Circulation. 2012;126:546–50. - PubMed
    1. Radeschi G, Mina A, Berta G, Fassiola A, Roasio A, Urso F, et al. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation. 2017;119:48–55. - PubMed
    1. Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85:987–92. - PubMed

Publication types