Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes.
In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths.



This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; P<0.001) and more likely to have a presenting rhythm of ventricular tachycardia/ventricular fibrillation (21% versus 17%; P<0.001). In the ICU, mean event rate/1000 bed-days was 0.337 (±0.215) compared with 0.109 (±0.079) for telemetry wards and 0.134 (±0.098) for unmonitored wards. Of patients with an arrest in the ICU, the adjusted mean survival to discharge was 0.140 (0.037) compared with the unmonitored wards 0.106 (0.037) and telemetry wards 0.193 (0.074). More IHCA events occurred in the ICU compared to the inpatient wards and there was a slight increase in events/1000 patient bed-days in both locations.



Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA.
Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, CO sarah.perman@ucdenver.edu.
Sarah M
SM
Perman
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Emily
E
Stanton
Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Jasmeet
J
Soar
Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, PA.
Robert A
RA
Berg
Beth Israel Deaconess Medical Center, Boston, MA.
Michael W
MW
Donnino
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Mark E
ME
Mikkelsen
Department of Internal Medicine, University of Chicago, Chicago, IL.
Dana P
DP
Edelson
Department of Internal Medicine, University of Chicago, Chicago, IL.
Matthew M
MM
Churpek
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Lin
L
Yang
Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Raina M
RM
Merchant
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000628:therapy; D013686:Telemetry; D014481:United States / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000628:therapy
critical care; in‐hospital cardiac arrest; outcome; resuscitation
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