Ransomware Cyberattack Associated With Cardiac Arrest Incidence and Outcomes at Untargeted, Adjacent Hospitals

Thaidan T. Pham, MD; Theoren M. Loo, MS; Atul Malhotra, MD; Christopher A. Longhurst, MD, MS; Diana Hylton, MD; Christian Dameff, MD, MS; Jeffrey Tully, MD; Gabriel Wardi, MD, MPH; Rebecca E. Sell, MD; Alex K. Pearce, MD

doi:10.1097/CCE.0000000000001079

Critical Care Explorations (Apr 2024)

Ransomware Cyberattack Associated With Cardiac Arrest Incidence and Outcomes at Untargeted, Adjacent Hospitals

Thaidan T. Pham, MD,
Theoren M. Loo, MS,
Atul Malhotra, MD,
Christopher A. Longhurst, MD, MS,
Diana Hylton, MD,
Christian Dameff, MD, MS,
Jeffrey Tully, MD,
Gabriel Wardi, MD, MPH,
Rebecca E. Sell, MD,
Alex K. Pearce, MD

Affiliations

Thaidan T. Pham, MD: 1 Department of Medicine, University of California San Diego, San Diego, CA.
Theoren M. Loo, MS: 2 Independent Researcher, San Diego, CA.
Atul Malhotra, MD: 3 Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California San Diego, San Diego, CA.
Christopher A. Longhurst, MD, MS: 4 Department of Medicine, Division of Biomedical Informatics, University of California San Diego, San Diego, CA.
Diana Hylton, MD: 6 Department of Anesthesiology, University of California San Diego, San Diego, CA.
Christian Dameff, MD, MS: 4 Department of Medicine, Division of Biomedical Informatics, University of California San Diego, San Diego, CA.
Jeffrey Tully, MD: 6 Department of Anesthesiology, University of California San Diego, San Diego, CA.
Gabriel Wardi, MD, MPH: 3 Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California San Diego, San Diego, CA.
Rebecca E. Sell, MD: 9 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
Alex K. Pearce, MD: 3 Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine & Physiology, University of California San Diego, San Diego, CA.

DOI: https://doi.org/10.1097/CCE.0000000000001079
Journal volume & issue: Vol. 6, no. 4
p. e1079

Abstract

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OBJECTIVES:. Healthcare ransomware cyberattacks have been associated with major regional hospital disruptions, but data reporting patient-oriented outcomes in critical conditions such as cardiac arrest (CA) are limited. This study examined the CA incidence and outcomes of untargeted hospitals adjacent to a ransomware-infected healthcare delivery organization (HDO). DESIGN, SETTING, AND PATIENTS:. This cohort study compared the CA incidence and outcomes of two untargeted academic hospitals adjacent to an HDO under a ransomware cyberattack during the pre-attack (April 3–30, 2021), attack (May 1–28, 2021), and post-attack (May 29, 2021–June 25, 2021) phases. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Emergency department and hospital mean daily census, number of CAs, mean daily CA incidence per 1,000 admissions, return of spontaneous circulation, survival to discharge, and survival with favorable neurologic outcome were measured. The study evaluated 78 total CAs: 44 out-of-hospital CAs (OHCAs) and 34 in-hospital CAs. The number of total CAs increased from the pre-attack to attack phase (21 vs. 38; p = 0.03), followed by a decrease in the post-attack phase (38 vs. 19; p = 0.01). The number of total CAs exceeded the cyberattack month forecast (May 2021: 41 observed vs. 27 forecasted cases; 95% CI, 17.0–37.4). OHCA cases also exceeded the forecast (May 2021: 24 observed vs. 12 forecasted cases; 95% CI, 6.0–18.8). Survival with favorable neurologic outcome rates for all CAs decreased, driven by increases in OHCA mortality: survival with favorable neurologic rates for OHCAs decreased from the pre-attack phase to attack phase (40.0% vs. 4.5%; p = 0.02) followed by an increase in the post-attack phase (4.5% vs. 41.2%; p = 0.01). CONCLUSIONS:. Untargeted hospitals adjacent to ransomware-infected HDOs may see worse outcomes for patients suffering from OHCA. These findings highlight the critical need for cybersecurity disaster planning and resiliency.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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