nach oben

Intensive Care Medicine

Erschienen in:

01.12.2014 | Original

Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013

verfasst von: I. Efendijev, R. Raj, M. Reinikainen, S. Hoppu, M. B. Skrifvars

Erschienen in: Intensive Care Medicine | Ausgabe 12/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To estimate temporal trends in incidence and hospital mortality after cardiac arrest in Finnish intensive care units.

Methods

Using a large nationwide intensive care unit (ICU) database we identified patients suffering from cardiac arrest following ICU admission (ICU-CA) during the study period (2003–2013). ICU-CA was defined as need for cardiopulmonary resuscitation and/or defibrillation (non-arrest cardioversions were excluded) according to the Therapeutic Intervention Scoring System-76. Patients admitted with an admission diagnosis of cardiac arrest were excluded. We determined crude incidence and risk-adjusted hospital mortality (based on a customized severity of illness model) for all ICU-CA patients, and for predefined admission diagnosis subgroups. Temporal trends for the observed period were calculated for crude incidence and risk-adjusted hospital mortality.

Results

Crude incidence for all ICU-CA patients was 29/1,000 ICU admissions, with the highest incidence 118/1,000 in the non-operative cardiovascular subgroup. Overall hospital mortality for ICU-CA patients was 55.5 % [95 % confidence interval (CI) 54–57 %]. Hospital mortality was 53.1 % (95 % CI 50.4–55.8 %) for non-operative cardiovascular ICU-CA patients, 32.9 % (95 % CI 26.9–38.9 %) for post cardiac surgery ICU-CA patients, and 56.3 % (95 % CI 51.2–61.3 %) for neurological/neurosurgical ICU-CA patients. There was a significant reduction in the overall ICU-CA incidence and in the risk-adjusted hospital mortality of ICU-CA and non-cardiac arrest cases (non-CA) over the observed study period (p < 0.001).

Conclusion

Our data suggest that the incidence of ICU-CA has decreased in Finnish ICUs between 2003 and 2013. Similar reduction in hospital mortality over time was observed for both ICU-CA and non-CA populations.

Nur mit Berechtigung zugänglich

Hollenberg J, Svensson L, Rosenqvist M (2013) Out-of-hospital cardiac arrest: 10 years of progress in research and treatment. J Intern Med 273:572–583. doi:10.1111/joim.12064 PubMedCrossRef

Girotra S, Nallamothu BK, Spertus JA et al (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367:1912–1920. doi:10.1056/NEJMoa1109148 PubMedCentralPubMedCrossRef

Peberdy MA, Kaye W, Ornato JP et al (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58:297–308. doi:10.1016/S0300-9572(03)00215-6 PubMedCrossRef

Dumot JA, Burval DJ, Sprung J et al (2001) Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitations. Arch Intern Med 161:1751–1758. doi:10.1001/archinte.161.14.1751 PubMedCrossRef

Efendijev I, Nurmi J, Castrén M, Skrifvars MB (2014) Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature. Resuscitation 85:472–479. doi:10.1016/j.resuscitation.2013.12.027 PubMedCrossRef

Smith DL, Kim K, Cairns BA et al (1995) Prospective analysis of outcome after cardiopulmonary resuscitation in critically ill surgical patients. J Am Coll Surg 180:394–401PubMed

Anthi A, Tzelepis GE, Alivizatos P et al (1998) Unexpected cardiac arrest after cardiac surgery: incidence, predisposing causes, and outcome of open chest cardiopulmonary resuscitation. Chest 113:15–19PubMedCrossRef

Wallace S, Ewer MS, Price KJ, Feeley TW (2002) Outcome and cost implications of cardiopulmonary resuscitation in the medical intensive care unit of a comprehensive cancer center. Support Care Cancer 10:425–429. doi:10.1007/s00520-002-0353-4 PubMedCrossRef

Enohumah KO, Moerer O, Kirmse C et al (2006) Outcome of cardiopulmonary resuscitation in intensive care units in a university hospital. Resuscitation 71:161–170. doi:10.1016/j.resuscitation.2006.03.013 PubMedCrossRef

10.

Skrifvars MB, Varghese B, Parr MJ (2012) Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation 83:728–733. doi:10.1016/j.resuscitation.2011.11.036 PubMedCrossRef

11.

Lee HK, Lee H, No JM et al (2013) Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand 57:784–792. doi:10.1111/aas.12117 PubMedCrossRef

12.

Chang SH, Huang CH, Shih CL et al (2009) Who survives cardiac arrest in the intensive care units? J Crit Care 24:408–414. doi:10.1016/j.jcrc.2008.10.006 PubMedCrossRef

13.

Grigoriyan A, Vazquez R, Palvinskaya T et al (2009) Outcomes of cardiopulmonary resuscitation for patients on vasopressors or inotropes: a pilot study. J Crit Care 24:415–418. doi:10.1016/j.jcrc.2009.02.005 PubMedCrossRef

14.

Guney MR, Ketenci B, Yapici F et al (2009) Results of treatment methods in cardiac arrest following coronary artery bypass grafting. J Card Surg 24:227–233. doi:10.1111/j.1540-8191.2008.00760.x PubMedCrossRef

15.

Karetzky M, Zubair M, Parikh J (1995) Cardiopulmonary resuscitation in intensive care unit and non-intensive care unit patients. Immediate and long-term survival. Arch Intern Med 155:1277–1280PubMedCrossRef

16.

Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG (2011) Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ 183:1589–1595. doi:10.1503/cmaj.100034 PubMedCentralPubMedCrossRef

17.

Landry FJ, Parker JM, Phillips YY (1992) Outcome of cardiopulmonary resuscitation in the intensive care setting. Arch Intern Med 152:2305–2308PubMedCrossRef

18.

Myrianthefs P, Kalafati M, Lemonidou C et al (2003) Efficacy of CPR in a general, adult ICU. Resuscitation 57:43–48. doi:10.1016/s0300-9572(02)00432-x PubMedCrossRef

19.

Peterson MW, Geist LJ, Schwartz DA et al (1991) Outcome after cardiopulmonary resuscitation in a medical intensive care unit. Chest 100:168–174PubMedCrossRef

20.

Rabinstein AA, McClelland RL, Wijdicks EF et al (2004) Cardiopulmonary resuscitation in critically ill neurologic-neurosurgical patients. Mayo Clin Proc 79:1391–1395. doi:10.4065/79.11.1391 PubMedCrossRef

21.

Tian J, Kaufman DA, Zarich S et al (2010) Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 182:501–506. doi:10.1164/rccm.200910-1639OC PubMedCrossRef

22.

Tortolani AJ, Risucci DA, Rosati RJ, Dixon R (1990) In-hospital cardiopulmonary resuscitation: patient, arrest and resuscitation factors associated with survival. Resuscitation 20:115–128PubMedCrossRef

23.

Yi HJ, Kim YS, Ko Y et al (2006) Factors associated with survival and neurological outcome after cardiopulmonary resuscitation of neurosurgical intensive care unit patients. Neurosurgery 59:836–838. doi:10.1227/01.NEU.0000232976.22414.D9 CrossRef

24.

Hazinski MF, Nolan JP, Billi JE et al (2010) Part 1: executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 122:S250–S275. doi:10.1161/CIRCULATIONAHA.110.970897 PubMedCrossRef

25.

Rea TD, Pearce RM, Raghunathan TE et al (2004) Incidence of out-of-hospital cardiac arrest. Am J Cardiol 93:1455–1460PubMedCrossRef

26.

Pell JP, Corstorphine M, McConnachie A et al (2006) Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management. Eur Heart J 27:406–412. doi:10.1093/eurheartj/ehi604 PubMedCrossRef

27.

Von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. doi:10.1016/j.jclinepi.2007.11.008 CrossRef

28.

Reinikainen M, Mussalo P, Hovilehto S et al (2012) Association of automated data collection and data completeness with outcomes of intensive care. A new customised model for outcome prediction. Acta Anaesthesiol Scand 56:1114–1122. doi:10.1111/j.1399-6576.2012.02669.x PubMedCrossRef

29.

Reinikainen M, Oksanen T, Leppänen P et al (2012) Mortality in out-of-hospital cardiac arrest patients has decreased in the era of therapeutic hypothermia. Acta Anaesthesiol Scand 56:110–115. doi:10.1111/j.1399-6576.2011.02543.x PubMedCrossRef

30.

Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636. doi:10.1378/chest.100.6.1619 PubMedCrossRef

31.

Keene AR, Cullen DJ (1983) Therapeutic intervention scoring system: update 1983. Crit Care Med 11:1–3PubMedCrossRef

32.

Legall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS-II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRef

33.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829. doi:10.1097/00003465-198603000-00013 PubMedCrossRef

34.

Vincent J-L, Moreno R, Takala J et al (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710. doi:10.1007/BF01709751 PubMedCrossRef

35.

Bakhshi-Raiez F, Peek N, Bosman RJ et al (2007) The impact of different prognostic models and their customization on institutional comparison of intensive care units. Crit Care Med 35:2553–2560. doi:10.1097/01.CCM.0000288123.29559.5A PubMedCrossRef

36.

Vaahersalo J, Hiltunen P, Tiainen M et al (2013) Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med 39:826–837. doi:10.1007/s00134-013-2868-1 PubMedCrossRef

37.

Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245PubMedCrossRef

38.

Al-Alwan A, Ehlenbach WJ, Menon PR et al (2014) Cardiopulmonary resuscitation among mechanically ventilated patients. Intensive Care Med 40:556–563PubMedCrossRef

39.

Nolan JP, Soar J, Zideman DA et al (2010) European Resuscitation Council guidelines for resuscitation 2010 section 1. Executive summary. Resuscitation 81:1219–1276PubMedCrossRef

40.

Kaukonen K-M, Bailey M, Suzuki S et al (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA 311:1308–1316. doi:10.1001/jama.2014.2637 PubMedCrossRef

41.

Cummins RO, Chamberlain D, Hazinski MF et al (1997) Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein style”. A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Resuscitation 34:151–183PubMedCrossRef

Titel: Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013
verfasst von: I. Efendijev
R. Raj
M. Reinikainen
S. Hoppu
M. B. Skrifvars
Publikationsdatum: 01.12.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3509-z

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2014

What’s new: the management of acute right ventricular decompensation of chronic pulmonary hypertension

Pathergy phenomenon: huge pyoderma gangrenosum following tube thoracostomy

Understanding the disease: aneurysmal subarachnoid hemorrhage

Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Early therapy with IgM-enriched polyclonal immunoglobulin in patients with septic shock

Erratum to: Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period

Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS