Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Ofoma, Uchenna R.¹  Basnet, Suresh²  Berger, Andrea³  Kirchner, H. Lester³  Girotra, Saket^4,5 

[1] Geisinger Hlth Syst, Dept Crit Care Med, 100 North Acad Ave, Danville, PA 17822 USA

[2] Winchester Med Ctr, Dept Crit Care Med, Winchester, Hants, England

[3] Geisinger Hlth Syst, Biomed & Translat Informat, Danville, PA USA

[4] Univ Iowa Hosp & Clin, Dept Med, Div Cardiovasc Dis, Iowa City, IA 52242 USA

[5] Iowa City Vet Affairs Med Ctr, Iowa City, IA USA

关键词: cardiac arrest;    cardiopulmonary resuscitation;    outcome;    patient safety;    return of spontaneous circulation;   

DOI  :  10.1016/j.jacc.2017.11.043

来源: Elsevier

【 摘 要 】

BACKGROUND Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. OBJECTIVES This study sought to examine temporal trends in survival differences between on-hours and off-hours IHCA. METHODS We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines-Resuscitation registry during 2000 to 2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday to Friday 7: 00 AM to 10: 59 PM) versus off-hours (Monday to Friday 11: 00 PM to 6: 59 AM, and Saturday to Sunday, all day). RESULTS Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; p for trend <0.001 for both). However, there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (p = 0.75) or a relative scale (p = 0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; p for trend <0.001 for both) and the difference between on-hours and off-hours narrowed over time (p = 0.02 absolute scale, p <0.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (p for trend <0.001 for both), the absolute and relative difference persisted. CONCLUSIONS Despite an overall improvement in survival, lower survival in IHCA during off-hours compared with on-hours persists. (C) 2018 by the American College of Cardiology Foundation.

【 授权许可】

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