Recurrent in-hospital cardiac arrests tied to worse outcomes
Patients with recurrent in-hospital cardiac arrests (IHCAs) have worse outcomes than patients with only a single event, a recent study has found. Despite this, rates of withdrawal of care and do not attempt resuscitation (DNAR) orders are lower for patients with recurrent IHCAs.
The study included 192,250 patients, of whom 86.1 percent (n=165,446) had no recurrent IHCA, 1.6 percent (n=3,162) had recurrent out-of-hospital cardiac arrest (OHCA) and 12.3 percent (n=22,643) had recurrent IHCA. Multivariable hierarchical logistic regression models were used to compare survival outcomes among patient groups.
Rates of survival to discharge were lower for those with recurrent IHCA than in those without (12.7 percent vs 22.1 percent). The overall rate of survival to discharge was 20.9 percent. Patients with recurrent IHCA were half as likely to survive to hospital discharge (adjusted odds ratio [OR], 0.46; 95 percent CI, 0.44–0.48; p<0.001).
In addition, recurrent IHCA was associated with significantly lower chances of having favourable neurological survival (7.0 percent vs 13.1 percent; adjusted OR, 0.44; 0.42–0.47; p<0.001).
In terms of end-of-life care, patients with vs without recurrent IHCA were less likely to have DNAR orders within the first 24 hours (17.2 percent vs 18.9 percent; p<0.001). Rates for withdrawal of care were likewise significantly lower patients with recurrent IHCA (17.7 percent vs 24.4 percent; p<0.001).
“These findings provide important prognostic information for clinicians and families of patients with recurrent IHCA and suggest a critical need to better align resuscitation and end-of-life decision-making with patients’ prognoses after IHCA,” said researchers.