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No change in survival after cardiac arrest in 2007 and 2012 at a hospital in Denmark
Resuscitation 87 (2015) e11
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor No change in survival after cardiac arrest in 2007 and 2012 at a hospital in Denmark Sir, The international guidelines on resuscitation are updated every five years. In the latest revision, there was focus on prevention, quality of resuscitation and post-care.1 But to date, no data on in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest in Denmark after the implementation of the latest guidelines, have been published. The aim of our study was to present data on patients suffering from cardiac arrest in relation to a hospital in Denmark. We performed a retrospective, single-center analysis of all cardiac arrests treated at Sydvestjysk Sygehus, a 450-bed regional teaching hospital, in 2007 and 2012. In 2007, the 2005 guidelines were fully implemented as were the 2010 revision in 2012. In 2007, a physician-manned ambulance was under implementation and it was fully implemented by 2010. Patients were identified from an in-house cardiac arrest register and we included all patients in cardiac arrest in any ward (designated IHCA) and patients brought to the Emergency Department with cardiac arrest (designated OHCA). Data were extracted from the charts. The study was approved by the Danish Data Protection Agency and approval from the local Ethics Committee was, according to Danish law, not required. Continuous data will be reported as median (range) and categorical data as proportions (%). Categorical data will be compared using the Chi-square-test and continuous data using the Mann–Whitney’s U-test. p-values <0.05 will be considered statistically significant. We identified 246 patients with cardiac arrest: 117 in 2007 and 129 in 2012. Median age was 67 years (range 27–99) and 72 years (range 2–96), respectively, and approximately 66% were male. The distribution between IHCA and OHCA changed, with a majority of OHCA in 2007 (74%) and IHCA in 2012 (54%), p < 0.001. Ventricular tachycardia and ventricular fibrillation as presenting rhythm remained unchanged (21 and 24%), while pulseless electrical activity and asystole decreased in OHCA (70–51%), p < 0.001. Overall, 23% obtained return of spontaneous circulation (ROSC) in 2007 and 47% in 2012, p < 0.001, but only with a significant increase in OHCA (21–61%). We found no increase in overall survival to discharge (88 and 86%), 7-day mortality (83 and 81%), 30-day mortality (88 and 86%) or 1-year mortality (91 and 89%), with no difference in both IHCA and OHCA. Survival of OHCA at our institution did not differ much from the previous reports, both national and international. According to the Danish Cardiac Arrest Register, 30-day survival rate after OHCA
http://dx.doi.org/10.1016/j.resuscitation.2014.11.017 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
was 8.6% in 2007 and 10.1% in 2011,2 while international reports indicate a higher survival rate of OCHA (17–22%).3,4 Our survival of IHCA was not very high. This is not only a challenge for our institution, but for hospitals worldwide. Patients admitted to a floor bed suffer from significant levels of illness and co-morbidity and carry a high risk of mortality, and a previous study at our institution have shown room for improvement.5 In conclusion, we found that the implementation of new resuscitation guidelines in 2010 has significantly increased resuscitation attempts terminated due to ROSC, but survival rates did not improve. Conflict of interest statement The authors state that they have no conflicts of interest to report. References 1. Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council Guidelines for Resuscitation 2010 section 1. Executive summary. Resuscitation 2010;81:1219–76. 2. Sundhedsstyrelsen Fakta om tal fra Dansk Hjertestopregister; 2013. http://sst.dk [accessed 24.10.14]. 3. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423–31. 4. Buanes EA, Heltne JK. Comparison of in-hospital and out-of-hospital cardiac arrest outcomes in a Scandinavian community. Acta Anaesthesiol Scand 2014;58:316–22. 5. Mondrup F, Brabrand M, Folkestad L, et al. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study. Scand J Trauma Resusc Emerg Med 2011;19:55.
Lisbeth Holmgaard Quitzau ∗ Department of Anesthesiology, Finsensgade 35, DK-6700 Esbjerg, Denmark Henriette Ullerup-Aagaard Department of Cardiology, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark Mikkel Brabrand a,b Emergency Department, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark b University of Southern Denmark, Institute for Regional Health Research, Finsensgade 35, DK-6700 Esbjerg, Denmark a
∗ Corresponding author. E-mail address: [email protected] (L.H. Quitzau)
10 November 2014
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor No change in survival after cardiac arrest in 2007 and 2012 at a hospital in Denmark Sir, The international guidelines on resuscitation are updated every five years. In the latest revision, there was focus on prevention, quality of resuscitation and post-care.1 But to date, no data on in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest in Denmark after the implementation of the latest guidelines, have been published. The aim of our study was to present data on patients suffering from cardiac arrest in relation to a hospital in Denmark. We performed a retrospective, single-center analysis of all cardiac arrests treated at Sydvestjysk Sygehus, a 450-bed regional teaching hospital, in 2007 and 2012. In 2007, the 2005 guidelines were fully implemented as were the 2010 revision in 2012. In 2007, a physician-manned ambulance was under implementation and it was fully implemented by 2010. Patients were identified from an in-house cardiac arrest register and we included all patients in cardiac arrest in any ward (designated IHCA) and patients brought to the Emergency Department with cardiac arrest (designated OHCA). Data were extracted from the charts. The study was approved by the Danish Data Protection Agency and approval from the local Ethics Committee was, according to Danish law, not required. Continuous data will be reported as median (range) and categorical data as proportions (%). Categorical data will be compared using the Chi-square-test and continuous data using the Mann–Whitney’s U-test. p-values <0.05 will be considered statistically significant. We identified 246 patients with cardiac arrest: 117 in 2007 and 129 in 2012. Median age was 67 years (range 27–99) and 72 years (range 2–96), respectively, and approximately 66% were male. The distribution between IHCA and OHCA changed, with a majority of OHCA in 2007 (74%) and IHCA in 2012 (54%), p < 0.001. Ventricular tachycardia and ventricular fibrillation as presenting rhythm remained unchanged (21 and 24%), while pulseless electrical activity and asystole decreased in OHCA (70–51%), p < 0.001. Overall, 23% obtained return of spontaneous circulation (ROSC) in 2007 and 47% in 2012, p < 0.001, but only with a significant increase in OHCA (21–61%). We found no increase in overall survival to discharge (88 and 86%), 7-day mortality (83 and 81%), 30-day mortality (88 and 86%) or 1-year mortality (91 and 89%), with no difference in both IHCA and OHCA. Survival of OHCA at our institution did not differ much from the previous reports, both national and international. According to the Danish Cardiac Arrest Register, 30-day survival rate after OHCA
http://dx.doi.org/10.1016/j.resuscitation.2014.11.017 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
was 8.6% in 2007 and 10.1% in 2011,2 while international reports indicate a higher survival rate of OCHA (17–22%).3,4 Our survival of IHCA was not very high. This is not only a challenge for our institution, but for hospitals worldwide. Patients admitted to a floor bed suffer from significant levels of illness and co-morbidity and carry a high risk of mortality, and a previous study at our institution have shown room for improvement.5 In conclusion, we found that the implementation of new resuscitation guidelines in 2010 has significantly increased resuscitation attempts terminated due to ROSC, but survival rates did not improve. Conflict of interest statement The authors state that they have no conflicts of interest to report. References 1. Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council Guidelines for Resuscitation 2010 section 1. Executive summary. Resuscitation 2010;81:1219–76. 2. Sundhedsstyrelsen Fakta om tal fra Dansk Hjertestopregister; 2013. http://sst.dk [accessed 24.10.14]. 3. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423–31. 4. Buanes EA, Heltne JK. Comparison of in-hospital and out-of-hospital cardiac arrest outcomes in a Scandinavian community. Acta Anaesthesiol Scand 2014;58:316–22. 5. Mondrup F, Brabrand M, Folkestad L, et al. In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study. Scand J Trauma Resusc Emerg Med 2011;19:55.
Lisbeth Holmgaard Quitzau ∗ Department of Anesthesiology, Finsensgade 35, DK-6700 Esbjerg, Denmark Henriette Ullerup-Aagaard Department of Cardiology, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark Mikkel Brabrand a,b Emergency Department, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark b University of Southern Denmark, Institute for Regional Health Research, Finsensgade 35, DK-6700 Esbjerg, Denmark a
∗ Corresponding author. E-mail address: [email protected] (L.H. Quitzau)
10 November 2014