Abstract Details

Title Variability in Hospital Mortality and Good Neurologic Outcome Following In-hospital Cardiac Arrest Within a Large Healthcare System

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-007

Objective

We sought to evaluate differences in outcome following in-hospital cardiac arrest (IHCA) within a large healthcare system.

Background Survival following IHCA varies. Differences in post-arrest management may explain some variation in outcomes.

Design/Methods In this retrospective analysis of IHCA patients admitted between January 2021 and December 2024 to one of five hospitals within a large healthcare system, data was obtained from a quality improvement database including all IHCA patients. Arrest location was documented as intensive care unit (ICU), emergency department (ED), or inpatient floor, the latter of which also included step down and telemetry units. The primary outcome was in-hospital mortality, and the secondary outcome was discharge home. Analysis of variance was used to compare continuous variables with two or more categories. Multivariate logistic regression, adjusting for age and sex, was used to compare outcomes across hospitals and arrest location.

Results

In total, 2,706 patients were included, of which 1,168 (43.2%) achieved return of spontaneous circulation (ROSC). ROSC rate variability between hospitals and by arrest location was not significant [37.7%-47.4%, p = 0.079 and ICU: 52.1-62.6%, ED: 59.1-69.8%, Floor: 54.4-72.3%, p=0.067]. Mortality rates were similar across hospitals (56.1-66.9%, p=0.296). Compared to ICU, where one third of IHCA occurred, ED and floor IHCA patients had lower mortality [OR (95% CI) 0.42 (0.31-0.56) and 0.40 (0.29-0.55)] and increased discharge home [OR 3.87 (2.66-5.72) and 3.68 (2.44-5.61), respectively]. ICU IHCA patients were more likely to experience early withdrawal of life sustaining therapy (27.1% vs 18.4%, p<0.001), less likely to be treated with temperature control (10.2% vs 21.8%, p<0.001) and less likely to undergo at least one neuroprognostic test (13.6% vs 29.2%, p<0.001).

Conclusions Within a large healthcare system, ICU IHCA was associated with increased mortality and decreased discharge to home. Early de-escalation of care may be a modifiable variable contributing to mortality in this population.

Authors/Disclosures
William McCarthy, RA PRESENTER	Mr. McCarthy has nothing to disclose.
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.
Kathryn M. Meehl, BS	Ms. Meehl has nothing to disclose.
Piyush Bahel	Mr. Bahel has nothing to disclose.
Laura DeVaux, RN	Mrs. DeVaux has nothing to disclose.
David K. Johnson, PhD	Prof. Johnson has nothing to disclose.
Akhil Khosla	Akhil Khosla has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Inari.
Melissa McKay, RN	Mrs. McKay has nothing to disclose.
P Elliott Miller	P Elliott Miller has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JCF-I.
Charles Wira	Charles Wira has nothing to disclose.
Sarah Perman (Yale School of Medicine)	Sarah Perman has received research support from National Institutes of Health.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.

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