Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

Race is not associated with medical emergency team evaluation prior to in-hospital cardiac arrest

BACKGROUND

Black patients have worse outcomes after in-hospital cardiac arrest (IHCA). Whether these racial disparities are associated with medical emergency team (MET) evaluation prior to IHCA remains unknown.

METHODS

A retrospective cohort study of adults age ≥ 18 years from the American Heart Association Get With The Guidelines® Resuscitation registry who had an IHCA between 2000 and 2021 with acute physiologic decline (modified early warning score [MEWS] ≥ 3) during the 24 h prior to IHCA. A propensity-weighted cohort was constructed to balance confounders between Black and White patients. The association between race and MET evaluation was quantified with weighted multivariable logistic regression.

RESULTS

Among 354,480 patients, 88,507 met the initial inclusion criteria, of which 29,714 patients (median age 69 [IQR 58-79] years, 42.5% female, and 26.9% Black) had acute physiologic decline during the 24 h prior to IHCA. Among patients with acute physiologic decline, 4102 (13.8%) patients had a preceding MET evaluation before IHCA. Rates of MET evaluation prior to cardiac arrest did not differ significantly between Black and White patients with acute physiologic decline (aOR 1.02, 95% CI 0.94-1.11, p = 0.62).

CONCLUSIONS

Though racial disparities in IHCA outcomes exist, this study did not detect a difference in rates of MET evaluation prior to IHCA among patients with acute physiologic decline as a potential mechanism for these disparities.

Comparing characteristics and outcomes of in-hospital cardiac arrest during the early and late COVID-19 pandemic at an academic institution in Saudi Arabia

BACKGROUND

The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims.

AIM

We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021).

METHODS

This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021.

RESULTS

Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p < 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p < 0.01), and were intubated less often (23.0% vs. 59.3%; p < 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p < 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p < 0.01) were lower during the early COVID-19 pandemic period.

CONCLUSIONS

The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period.

Increased survival for resuscitated Utstein-comparator group patients conveyed directly to cardiac arrest centres in a large rural and suburban population in England

AIM

The cohort of patients in which cardiac arrest centres (CAC) in rural and suburban populations confer the greatest survival benefit remains unclear. The aim of this study was to assess whether the transfer of resuscitated Utstein-comparator out-of-hospital cardiac arrest (OHCA) patients direct to a CAC was associated with improved survival to hospital discharge compared to patients conveyed to non-specialist centres.

METHODS

A consecutive sample of adult (≥18 years old) Utstein-comparator patients (witnessed collapse and initial shockable rhythm) were included from the East of England Ambulance Service NHS Trust Utstein resuscitation registry; 2018-2022. Logistic regression was used to compare survival to discharge in patients transported to CACs compared with patients transported to non-specialist centres.

RESULTS

During the study period, resuscitation was attempted in 18,276 OHCA patients. N = 2448 (13.4%) met the Utstein-comparator definition and 1151 patients were included in the final analysis; per protocol. Survival was greater for patients conveyed directly to a CAC (n = 768, 60.7%) compared to non-specialist centres (n = 383, 47.3%); adjusted OR 1.44 (95%CI 1.07-1.94),p = 0.017. Amongst the centres analysed in this study, there was significant inter-hospital variability in survival between CACs (p = 0.017). There was no association between patient volume and survival (p = 0.850).

CONCLUSION

Direct transport to a cardiac arrest centre was associated with a 44% increase in the odds of survival compared to conveyance to a non-specialist centre for resuscitated adult patients presenting with witnessed collapse and initial shockable OHCA rhythm.