Survival after cardiopulmonary arrest in a tertiary care hospital in Turkey

Abstract

BACKGROUND: Despite significant improvements in the field of cardiopulmonary resuscitation (CPR) over the past 40 years, disparate survival rates are reported after in-hospital cardiac arrest (IHCA). Few studies have addressed the effect of comorbid conditions on survival after IHCA. OBJECTIVE: Examine IHCAs over a two-year period, determine survival rates, and assess the effects of comorbid diseases on survival after IHCA. DESIGN: Retrospective, cross-sectional study. SETTING: Tertiary care hospital in Turkey. PATIENTS AND METHODS: Patients who had an IHCA recorded in the data management system between 1 January 2016 and 31 December 2017 were evaluated using Utstein-style records for data collection. The Charlson Comorbidity Index (CCI) was scored retrospectively. MAIN OUTCOME MEASURES: Return of spontaneous circulation (ROSC), survival in the first 24 hours, survival longer than 24 hours, and survival up to 6 months after discharge, CCI score, gender, age, location of IHCA, and first documented heart rhythm. SAMPLE SIZE: 370 IHCA cases. RESULTS: Of 502 patient, 370 met inclusion criteria. The presence of shockable rhythm was low (15.7%). The CCI was ≤3 in 10% (n=37) of all patients. A CPR duration of ≥20 minutes was the most important risk factor for ROSC. CCI ≥6 reduced ROSC-achieved cases by 2.8-fold (P=.036) and increased the mortality rate by 2.8 fold (P=.041). IHCA was most frequent in intensive care units (60.3%, n=223). CONCLUSION: Assessing patients at risk in the hospital for comorbid conditions by CCI would be beneficial to prevent deaths related to IHCA. Close monitoring of patients with high CCI scores is advisable, as is making IHCA calls on time. LIMITATIONS: Retrospective, small sample size, and no evaluation of the neurological condition of the discharged patients. CONFLICT OF INTEREST: None.