The link between initial cardiac rhythm and survival outcomes in in-hospital cardiac arrest using propensity score matching, adjustment, and weighting

Abstract

Abstract The association between the initial cardiac rhythm and short-term survival in patients with in-hospital cardiac arrest (IHCA) has not been extensively studied despite the fact that it is thought to be a prognostic factor in patients with out-of-hospital cardiac arrest. This study aimed to look at the relationship between initial shockable rhythm and survival to hospital discharge in individuals with IHCA. 1516 adults with IHCA who received chest compressions lasting at least two minutes at the National Taiwan University Hospital between 2006 and 2014 made up the study population. Propensity scores were estimated using a fitted multivariate logistic regression model. Various statistical methodologies were employed to investigate the association between shockable rhythm and the probability of survival to discharge in patients experiencing IHCA, including multivariate adjustment, propensity score adjustment, propensity score matching, and logistic regression based on propensity score weighting. In the original cohort, the multivariate-adjusted odds ratio (OR) was 2.312 (95% confidence interval [CI]: 1.515–3.531, P < 0.001). In additional propensity score adjustment, the OR between shockable rhythm and the probability of survival to hospital discharge in IHCA patients was 2.282 (95% CI: 1.486, 3.504, P < 0.001). The multivariate-adjusted logistic regression model analysis revealed that patients with shockable rhythm had a 1.761-fold higher likelihood of surviving to hospital release in the propensity score-matched cohort (OR = 2.761, 95% CI: 1.084–7.028, P = 0.033). The multivariate-adjusted OR of the inverse probability for the treatment-weighted cohort was 1.901 (95% CI: 1.507–2.397, P < 0.001), and the standardized mortality ratio-weighted cohort was 2.692 (95% CI: 1.511–4.795, P < 0.001). In patients with in-hospital cardiac arrest, Initial cardiac rhythm is an independent predictor of survival to hospital discharge. Depending on various statistical methods, patients with IHCA who have a shockable rhythm have a one to two fold higher probability of survival to discharge than those who have a non-shockable rhythm. This provides a reference for optimizing resuscitation decisions for IHCA patients and facilitating clinical communication.

Keywords

• Shockable rhythm
• Inverse probability of treatment weighted
• Propensity score matching
• In-hospital cardiac arrest
• Standardized mortality ratio weighted