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The epidemiology of in-hospital cardiac arrests in Australia and New Zealand.
Intern Med J. 2016 Feb 10;
Authors: Fennessy G, Hilton A, Radford S, Bellomo R, Jones D
Abstract
BACKGROUND: The epidemiology of in-hospital cardiac arrests (IHCAs) in Australia and New Zealand (ANZ) has not been systematically assessed.
AIM: To conduct a systematic review of the frequency, characteristics and outcomes of adult IHCAs in ANZ.
METHOD: Medline search for studies published 1964 to 2014 using MeSH terms "arrest AND hospital AND Australia", "arrest AND hospital AND New Zealand", "inpatient AND arrest AND Australia", and "inpatient AND arrest AND New Zealand".
RESULTS: We screened 934 studies, analysed 50 and included 30. Frequency of IHCAs ranged from 1.31-6.11 per 1000 admissions in four population studies and 0.58-4.59 per 1000 in 16 cohort studies. The frequency was 4.11 vs 1.32 per 1000 admissions in hospitals with rapid response system (RRS) compared to those without (OR: 0.32; 95% CI 0.28-0.37; p < 0.001). On aggregate, the initial cardiac rhythm was ventricular tachycardia/fibrillation in 31.4% (range 19.0-48.8%) in 10 studies reporting such data. On aggregate, IHCAs were witnessed in 80.2% cases (three studies) and monitored patients in 53.4% cases (four studies). Details of life support were poorly documented. On aggregate, return of spontaneous circulation (ROSC) occurred in 46.0% of patients. Overall, 74.6% (range 59.4-77.5%) died in-hospital but survival was higher among monitored or younger patients, in those with a shockable rhythm, or during working hours.
CONCLUSIONS: IHCAs are uncommon in ANZ and three quarters die in hospital. However, their frequency varies markedly across institutions and may be affected by the presence of RRS. Where reported, the long term outcomes survivors appear to have acceptable neurological outcomes.
PMID: 26865245 [PubMed - as supplied by publisher]