Karthik Kailasam MD, n/a
Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Abhishek Bhardwaj, MD, FACP
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Justin Hanks, DO
Chief Medical Resident
Cleveland Clinic Main Campus
Cleveland, Ohio
Disclosure information not submitted.
Tarik Hanane MD, n/a
Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Deborah Rathz MD Ph.D., n/a
Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Xiaozhen Han MS, n/a
MS
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Xiaofeng Wang, PhD
Biostatistician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
David Gaieski, MD, FCCM
Professor
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Eduardo Mireles-Cabodevila, MD
Director , Medical Intensive Care Unit
Cleveland Clinic - Respiratory Institute
Cleveland, Ohio
Disclosure information not submitted.
Abhijit Duggal, MD, MPH, MSc, FACP
Assistant Professor
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Sudhir Krishnan, MD
Pulmonary and Critical Care Medicine Attending
Cleveland Clinic, Ohio, United States
Disclosure information not submitted.
Title: Outcomes After In-hospital Cardiac Arrest: Insights from a Medical Intensive Care Unit
Introduction: Critically ill patients admitted to the medical intensive care units (MICU) usually suffer from life-threatening illnesses and many are hemodynamically unstable. The incidence of cardiac arrest in the intensive care unit (ICU) is approximately 22 per 1000 admissions and survival to discharge after In-hospital cardiac arrest (IHCA) is approximately 14%. Variables associated with IHCA survival are poorly understood and the outcomes of cardio-pulmonary resuscitation (CPR) are poorly reported in the literature. We investigated the characteristics of IHCA and factors that are associated with poor IHCA survival.
Methods: We performed a retrospective single-center observational study to identify the outcomes of IHCA in a quaternary center MICU. We included all critically ill adult patients (age >18, N=384) with IHCA admitted to the MICU from January 2014 to December 2018.
Results: A total of 384 patients underwent CPR during the study period. The most common initial arrest rhythm was pulseless electrical activity (PEA) (72.2%). The mean duration of CPR was 11.5 minutes (IQR 4-17 minutes). Return of spontaneous circulation (ROSC) was obtained in 228 patients (59.4%). Sixty-one IHCA patients (16%) survived to hospital discharge. Hospital survivors were more likely than non-survivors to have a shockable rhythm at the time of arrest (20.7% vs 7.5%; p=0.001) and shorter average CPR duration (5.4 minutes vs 12.6 minutes; p< 0.0001). After adjusting for age, APACHE III score, and initial rhythm every one-minute increase in CPR duration was associated with 1.15 odds (95% CI 1.06-1.26; p< 0.001) of death at hospital discharge.
Conclusion: We report a survival to hospital discharge rate of 16% after an IHCA in the MICU. Survival to hospital discharge is associated with an initial shockable rhythm and inversely proportional to the duration of CPR.