title: Factors associated with re-arrest following initial resuscitation from cardiac arrest.
abstract: To examine patient- and arrest-level factors associated with the incidence of re-arrest in the hospital setting, and to measure the association between re-arrest and survival to discharge.
  
  
  
  This work represents a retrospective cohort study of adult patients who were successfully resuscitated from an initial out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (ICHA) of non-traumatic origin at two urban academic medical centers. In this study, re-arrest was defined as loss of a pulse following 20min of sustained return of spontaneous circulation (ROSC).
  
  
  
  Between 01/2005 and 04/2016, 1961 patients achieved ROSC following non-traumatic cardiac arrest. Of those, 471 (24%) experienced at least one re-arrest. In re-arrest patients, the median time from initial ROSC to first re-arrest was 5.4h (IQR: 1.1, 61.8). The distribution of initial rhythms between single- and re-arrest patients did not vary, nor did the median duration of initial arrest. Among 108 re-arrest patients with an initial shockable rhythm, 60 (56%) experienced a shockable re-arrest rhythm. Among 273 with an initial nonshockable rhythm, 31 (11%) experienced a shockable re-arrest rhythm. After adjusting for significant covariates, the incidence of re-arrest was associated with a lower likelihood of survival to discharge (OR: 0.32; 95% CI: 0.24-0.43; p<0.001).
  
  
  
  Re-arrest is a common complication experienced by cardiac arrest patients that achieve ROSC, and occurs early in the course of their post-arrest care. Moreover, re-arrest is associated with a decreased likelihood of survival to discharge, even after adjustments for relevant covariates.
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Bhardwaj
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ikeda
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kelsey R
authors.initials: KR
authors.lastname: Sheak
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Delfin
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Layden
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: marion.leary@uphs.upenn.edu.
authors.forename: Marion
authors.initials: M
authors.lastname: Leary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Advanced cardiac life support; Cardiopulmonary resuscitation; Critical care outcomes; Epidemiology; Heart arrest; Risk factors