Introduction

In-hospital cardiac arrest (IHCA) is acutely life-threatening and remains associated with high mortality and morbidity. Identifying predictors of mortality after IHCA would help to guide acute therapy.

Methods

We determined patient characteristics and independent predictors of 30-day in-hospital mortality, neurological outcome, and discharge/referral pathways in patients experiencing IHCA in a large tertiary care hospital between January 2014 and April 2017. Multivariable Cox regression model was fitted to assess predictors of outcomes.

Results

A total of 368 patients with IHCA were analysed (median age 73 years (interquartile range 65–78), 123 (33.4%) women). Most patients (45.9%) had an initial non-shockable rhythm and shockable rhythms were found in 20.9%; 23.6% of patients suffered from a recurrent episode of cardiac arrest. 172/368 patients died within 30 days (46.7%). Of 196/368 patients discharged alive after IHCA, the majority (72.9%, n = 143) had a good functional neurological outcome (modified Rankin Scale ≤ 3 points). In the multivariable analysis, return of spontaneous circulation without mechanical circulatory support (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.21–0.64), invasive coronary angiography and/or percutaneous intervention (HR 0.56, 95% CI 0.34–0.92), and antibiotic therapy (HR 0.87, 95% CI 0.83–0.92) were associated with a lower risk of 30-day in hospital mortality.

Conclusion

In the present study, IHCA was survived in ~ 50% in a tertiary care hospital, although only a minority of patients presented with shockable rhythms. The majority of IHCA survivors (~ 70%) had a good neurological outcome. Recovery of spontaneous circulation and presence of treatable acute causes of the arrest are associated with better survival.

Graphical abstract

Clinical Characteristics, Causes and Predictors of Outcomes in Patients with In-Hospital Cardiac Arrest: Results from the SURVIVE-ARREST Study. Abbreviations: CPR, cardiopulmonary resuscitation; IHCA, In-hospital cardiac arrest; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; SBP, systolic blood pressure.

中文翻译：

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院内心脏骤停患者的临床特征、原因和预后预测因素：SURVIVE-ARREST 研究的结果

介绍

院内心脏骤停 (IHCA) 会严重危及生命，并且仍然与高死亡率和发病率相关。确定 IHCA 后死亡率的预测因素将有助于指导急性治疗。

方法

我们确定了 2014 年 1 月至 2017 年 4 月期间在一家大型三级医院接受 IHCA 的患者的患者特征和 30 天院内死亡率、神经系统结果和出院/转诊途径的独立预测因子。多变量 Cox 回归模型用于评估预测因子结果。

结果

共分析了 368 名 IHCA 患者（中位年龄 73 岁（四分位数间距 65-78），123 名 (33.4%) 女性）。大多数患者 (45.9%) 的初始心律不可电击，20.9% 的患者出现可电击心律；23.6% 的患者反复发作心脏骤停。172/368 名患者在 30 天内死亡 (46.7%)。在 IHCA 后存活出院的 196/368 名患者中，大多数（72.9%，n = 143) 具有良好的功能神经学结果（改良 Rankin 量表 ≤ 3 分）。在多变量分析中，在没有机械循环支持的情况下恢复自主循环（风险比 (HR) 0.36，95% 置信区间 (CI) 0.21–0.64），有创冠状动脉造影和/或经皮介入治疗（HR 0.56，95% CI 0.34– 0.92）和抗生素治疗（HR 0.87，95% CI 0.83–0.92）与较低的 30 天住院死亡率风险相关。

结论

在本研究中，IHCA 在三级医院中的存活率约为 50%，尽管只有少数患者出现可电击节律。大多数 IHCA 幸存者 (~ 70%) 有良好的神经学结果。自主循环的恢复和可治疗的急性停搏原因的存在与更好的存活率相关。

图形概要

院内心脏骤停患者的临床特征、原因和预后预测因素：SURVIVE-ARREST 研究的结果。缩写：CPR，心肺复苏；IHCA，院内心脏骤停；MCS，机械循环支持；PCI，经皮冠状动脉介入治疗；ROSC，自主循环恢复；SBP，收缩压。