Trends in Return of Spontaneous Circulation and Survival to Hospital Discharge for In-Intensive Care Unit Cardiac Arrests.

RATIONALE: Nearly 3 in 5 in-hospital cardiac arrests occur in the ICU, yet large scale data on the outcomes of in-ICU cardiac arrests have not been published for over a decade.

OBJECTIVE: We sought to examine outcomes of in-ICU cardiac arrests evaluating both achievement of ROSC and subsequent survival to hospital discharge and how these have changed over time and by type of cardiac arrest.

METHODS: This was an observational study using the Get With The Guidelines® (GWTG-R) registry, an American Heart Associated (AHA)-sponsored, prospective multisite registry of in-hospital cardiac arrest in the United States, including adults >=18 years of age with a confirmed initial cardiac arrest occurring in the ICU who underwent resuscitation. Outcomes included achievement of return of spontaneous circulation (ROSC) and survival to hospital discharge. Multivariable hierarchical logistic regression adjusting for patient-level factors and hospitals as random effects was used to evaluate ROSC and survival.

RESULTS: 114,371 adult, in-ICU IHCA from January 2006 to December 2018 were studied. The mean age was 63.8 years, 41.3% were women, and 82.1% had a non-shockable initial rhythm. Of the 114,371 ICU cardiac arrests, 70,610 (61.7%) achieved return of spontaneous circulation (ROSC), and 21,747 (19.0%) survived until hospital discharge. The rate of ROSC improved from 2006-2018 (unadjusted 55.0% to 65.4%, adjusted OR per year 1.04; 95% CI [1.03, 1.05]). There was an increase in overall survival to discharge during this time (unadjusted 16.7% to 20.5%, adjusted OR per year 1.03; 95% CI [1.03, 1.04]). The survival to discharge rate of the 70,610 patients who achieved ROSC increased slightly (unadjusted 30.3% to 31.4%, OR per year 1.02; 95% CI [1.01, 1.02]).

CONCLUSION: There is an increase in survival to discharge for patients who experienced a cardiac arrest in the ICU between 2006-2018. There is an increase in achievement of ROSC and post-ROSC survival to discharge although the increase in achievement of ROSC was greater than the increase in post-ROSC survival.