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In-hospital cardiac arrest may be underestimated in US
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The annual incidence of in-hospital cardiac arrests between 2008 and 2017 in the United States was an estimated 292,000 for adults and 15,200 for children, which was substantially higher than what was previously estimated, according to a study published in Circulation: Cardiovascular Quality and Outcomes.
“With these new incidence numbers and the fact that in-hospital cardiac arrest has a very high mortality with approximately 75% of adults and 60% of children dying before hospital discharge, it is clear that increased clinical and research focus is needed,” Lars W. Andersen, MD, MPH, PhD, DMSc, associate professor at Aarhus University in Denmark and at the time of the study a visiting researcher at the department of emergency medicine at Beth Israel Deaconess Medical Center, told Cardiology Today. “There have been improvements over the last decades, but there is still much to do.”
Mathias J. Holmberg, MD, MPH, research fellow at the Center for Resuscitation Science at Beth Israel Deaconess Medical Center, and colleagues analyzed data from 167,013 cardiac arrests that occurred in 398 hospitals between 2008 and 2017. Data were obtained from the Get With the Guidelines-Resuscitation registry and the American Hospital Association Annual Survey. Adults and children were included in this study.
In-hospital cardiac arrest occurred in an estimated 15,200 children and 292,000 adults (95% prediction interval, 217,600-503,500) per year. Of these, there were 8,100 cases of non-pulseless events (95% prediction interval, 4,700-11,500) and 7,100 pulseless cardiac arrests (95% prediction interval, 4,400-9,900) per year.
From 2008 to 2017, pediatric cases of in-hospital cardiac arrests remained stable as adult cases increased over time.
The average annual incidence for in-hospital cardiac arrest for adults was 357,900 when index and recurrent events were included (95% prediction interval, 247,100-598,400). The incidence for children was 19,900. There were 11,600 non-pulseless events (95% prediction interval, 6,400-16,700) and 8,300 pulseless cardiac arrests (95% prediction interval, 4,900-11,200).
“Unfortunately, there is very little evidence to support prevention and treatment of in-hospital cardiac arrest,” Andersen said in an interview. “We recently addressed this in a JAMA review article (Andersen LW, et al. JAMA. 2019;doi:10.1001/jama.2019.1696.). There is therefore a very substantial need for additional research to prevent in-hospital cardiac arrest and optimize treatment when it occurs.” – by Darlene Dobkowski
For more information:
Lars W. Andersen, MD, MPH, PhD, DMSc, can be reached at the Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, J103, 8200 Aarhus N; email: lwandersen@clin.au.dk.
Disclosures: Andersen reports he is a compensated statistical reviewer for JAMA. The authors report no relevant financial disclosures.
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