Clinical Features and Outcomes of In-hospital Cardiac Arrest in Code Blue Events: a Retrospective Observational Study

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Nov 29

PMID 38028464

Authors

Masayuki Akatsuka

Hiroomi Tatsumi

Yoshiki Masuda

Affiliations

Soon will be listed here.

Abstract

Background: In-hospital cardiac arrest (IHCA) is a critical medical event with outcomes less researched compared to out-of-hospital cardiac arrest. This retrospective observational study aimed to investigate key aspects of IHCA epidemiology and prognosis in patients with Code Blue activation.

Methods: This retrospective observational study enrolled patients with Code Blue events in our hospital between January 2010 and October 2019. Participant characteristics, including age and sex, and IHCA characteristics, including the time of cardiac arrest, witnessed event, bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, vital signs at 1 and 6 h before IHCA, survival to hospital discharge (SHD), and the cardiac arrest survival postresuscitation in-hospital (CASPRI) score were included in univariate and multivariate logistic regression analyses with SHD as the primary endpoint.

Results: From the 293 Code Blue events that were activated during the study period, 81 participants were enrolled. Overall, the SHD rate was 28.4%, the median CPR duration was 14 (interquartile range, 6-28) min, and the rate of initial shockable rhythm was 19.8%. There were significant intergroup differences between the SHD and non-SHD groups in the CPR duration, shockable rhythm, and CASPRI score on univariate logistic regression analysis. Multivariate logistic regression analysis showed that the CASPRI score was the most accurate predictive factor for SHD (OR = 0.98, = 0.006).

Conclusions: The CASPRI score is associated with SHD in patients with IHCA during Code Blue events. Therefore, the CASPRI score of IHCA patients potentially constitutes a simple, useful adjunctive tool for the management of post-cardiac arrest syndrome.

Citing Articles

Validation of CASPRI, GO-FAR, PIHCA scores in predicting favorable neurological outcomes after in-hospital cardiac arrest; A five-year three center retrospective study in IRAN.

Alamuti F, Hosseinigolafshani S, Ranjbaran M, Yekefallah L BMC Cardiovasc Disord. 2024; 24(1):603.

PMID: 39472823 PMC: 11520468. DOI: 10.1186/s12872-024-04229-8.

References

Chan P, Spertus J, Krumholz H, Berg R, Li Y, Sasson C . A validated prediction tool for initial survivors of in-hospital cardiac arrest. Arch Intern Med. 2012; 172(12):947-53. PMC: 3517176. DOI: 10.1001/archinternmed.2012.2050. View

Merchant R, Yang L, Becker L, Berg R, Nadkarni V, Nichol G . Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011; 39(11):2401-6. PMC: 3196742. DOI: 10.1097/CCM.0b013e3182257459. View

Merchant R, Berg R, Yang L, Becker L, Groeneveld P, Chan P . Hospital variation in survival after in-hospital cardiac arrest. J Am Heart Assoc. 2014; 3(1):e000400. PMC: 3959682. DOI: 10.1161/JAHA.113.000400. View

Che-Hung Tsai J, Ma J, Liu S, Lin T, Hu S . Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest. J Clin Med. 2021; 10(21). PMC: 8584360. DOI: 10.3390/jcm10215131. View

Nolan J, Soar J, Smith G, Gwinnutt C, Parrott F, Power S . Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014; 85(8):987-92. DOI: 10.1016/j.resuscitation.2014.04.002. View

Chan P, Nichol G, Krumholz H, Spertus J, Jones P, Peterson E . Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009; 302(11):1195-201. PMC: 2795316. DOI: 10.1001/jama.2009.1340. View

Peberdy M, Kaye W, Ornato J, Larkin G, Nadkarni V, Mancini M . Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003; 58(3):297-308. DOI: 10.1016/s0300-9572(03)00215-6. View

Fairbanks R, Shah M, Brooke Lerner E, Ilangovan K, Pennington E, Schneider S . Epidemiology and outcomes of out-of-hospital cardiac arrest in Rochester, New York. Resuscitation. 2006; 72(3):415-24. DOI: 10.1016/j.resuscitation.2006.06.135. View

Benjamin E, Blaha M, Chiuve S, Cushman M, Das S, Deo R . Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017; 135(10):e146-e603. PMC: 5408160. DOI: 10.1161/CIR.0000000000000485. View

10.

Ehlenbach W, Barnato A, Curtis J, Kreuter W, Koepsell T, Deyo R . Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009; 361(1):22-31. PMC: 2917337. DOI: 10.1056/NEJMoa0810245. View

11.

Grasner J, Lefering R, Koster R, Masterson S, Bottiger B, Herlitz J . EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016; 105:188-95. DOI: 10.1016/j.resuscitation.2016.06.004. View

12.

Girotra S, Nallamothu B, Spertus J, Li Y, Krumholz H, Chan P . Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20):1912-20. PMC: 3517894. DOI: 10.1056/NEJMoa1109148. View

13.

Panchal A, Berg K, Hirsch K, Kudenchuk P, Rios M, Cabanas J . 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association.... Circulation. 2019; 140(24):e881-e894. DOI: 10.1161/CIR.0000000000000732. View

14.

Chan P, Krumholz H, Nichol G, Nallamothu B . Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008; 358(1):9-17. DOI: 10.1056/NEJMoa0706467. View

15.

Adielsson A, Hollenberg J, Karlsson T, Lindqvist J, Lundin S, Silfverstolpe J . Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. 2011; 97(17):1391-6. DOI: 10.1136/hrt.2011.222711. View

16.

Wang C, Chang W, Huang C, Tsai M, Yu P, Wu Y . Validation of the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score in an East Asian population. PLoS One. 2018; 13(8):e0202938. PMC: 6107241. DOI: 10.1371/journal.pone.0202938. View

17.

Kiguchi T, Okubo M, Nishiyama C, Maconochie I, Ong M, Kern K . Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020; 152:39-49. DOI: 10.1016/j.resuscitation.2020.02.044. View