A 20-year perspective of in hospital cardiac arrest: Experiences from a university hospital with focus on wards with and without monitoring facilities

Abstract

Background: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.

Aim: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.

Settings: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.

Methods: Retrospective registry study. Patients were assessed in four fiveyear intervals.

Inclusion criteria: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.

Exclusion criteria: Age below 18years.

Results: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.

Conclusion: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.

Keywords: CPC-score; CPR; Defibrillation; Delay; In-hospital cardiac arrest; Survival.