Variability in Hospital Mortality and Good Neurologic Outcome Following In-hospital Cardiac Arrest Within a Large Healthcare System
Rachel Beekman1, William McCarthy1, Kathryn Meehl1, Piyush Bahel2, Laura Devaux3, Jennifer Johnson3, Akhil Khosla1, Melissa McKay3, P. Elliott Miller1, Charles Wira1, Sarah Perman1, Emily Gilmore1
1Yale School of Medicine, 2University of Connecticut, 3Yale New Haven Hospital
Objective:
We sought to evaluate differences in outcome following in-hospital cardiac arrest (IHCA) within a large healthcare system.
Background:
Survival following IHCA varies. Differences in post-arrest management may explain some variation in outcomes.
Design/Methods:
In this retrospective analysis of IHCA patients admitted between January 2021 and December 2024 to one of five hospitals within a large healthcare system, data was obtained from a quality improvement database including all IHCA patients. Arrest location was documented as intensive care unit (ICU), emergency department (ED), or inpatient floor, the latter of which also included step down and telemetry units. The primary outcome was in-hospital mortality, and the secondary outcome was discharge home. Analysis of variance was used to compare continuous variables with two or more categories. Multivariate logistic regression, adjusting for age and sex, was used to compare outcomes across hospitals and arrest location.
Results:
In total, 2,706 patients were included, of which 1,168 (43.2%) achieved return of spontaneous circulation (ROSC). ROSC rate variability between hospitals and by arrest location was not significant [37.7%-47.4%, p = 0.079 and ICU: 52.1-62.6%, ED: 59.1-69.8%, Floor: 54.4-72.3%, p=0.067]. Mortality rates were similar across hospitals (56.1-66.9%, p=0.296). Compared to ICU, where one third of IHCA occurred, ED and floor IHCA patients had lower mortality [OR (95% CI) 0.42 (0.31-0.56) and 0.40 (0.29-0.55)] and increased discharge home [OR 3.87 (2.66-5.72) and 3.68 (2.44-5.61), respectively]. ICU IHCA patients were more likely to experience early withdrawal of life sustaining therapy (27.1% vs 18.4%, p<0.001), less likely to be treated with temperature control (10.2% vs 21.8%, p<0.001) and less likely to undergo at least one neuroprognostic test (13.6% vs 29.2%, p<0.001).
Conclusions:
Within a large healthcare system, ICU IHCA was associated with increased mortality and decreased discharge to home. Early de-escalation of care may be a modifiable variable contributing to mortality in this population.
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