Elsevier

Resuscitation

Volume 85, Issue 8, August 2014, Pages 987-992
Resuscitation

Clinical Paper
Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit

https://doi.org/10.1016/j.resuscitation.2014.04.002Get rights and content

Abstract

Objective

To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database.

Methods

A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge.

Results

The overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2–2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals.

Conclusions

These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest.

Introduction

The treatment of in-hospital cardiac arrest accounts for a significant workload in most acute hospitals in the United Kingdom (UK) and internationally. Despite this, there are no reliable national data to enable accurate determination of the incidence and outcome of in-hospital cardiac arrest in the UK. Data from a single UK general hospital in 1999 documented an incidence of in-hospital cardiac arrest of 3.6 per 1000 admissions (equivalent to 0.3 per 1000 population).1 A one-off audit undertaken in 1997 of in-hospital cardiac arrest in 49 UK hospitals reported a survival rate to hospital discharge of 17.6% but the number of hospital admissions over the audit period was not documented.2

A review of in-hospital cardiac arrest studies internationally documented incidences in the range of 1–5 per 1000 hospital admissions but with widely variable survival rates (0–42%).3 A recent analysis of the American Heart Association (AHA) Get with the Guidelines (GWTG)-Resuscitation registry, that included 358 hospitals with at least 50 adult in-hospital cardiac arrest cases between 2000 and 2009, documented a median incidence of 4.02 in-hospital cardiac arrests per 1000 hospital admissions (interquartile range (IQR), 2.95–5.65 per 1000 admissions).4 The median survival rate to hospital discharge for this period was 18.8% (IQR 14.5–22.6%).

In the UK, clinical guidelines for the prevention and treatment of cardiac arrest are updated at least every five years. However, the impact of guideline changes and other interventions on the incidence and outcome of in-hospital cardiac arrest can be determined only if these data can be collected consistently and reliably. Data from the AHA GWTG-Resuscitation registry indicate that risk-adjusted rates of survival to discharge after in-hospital cardiac arrest have increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval (CI) 1.03–1.06; P < 0.001 for trend).5

The Resuscitation Council (UK) and the Intensive Care National Audit & Research Centre (ICNARC) have collaborated to establish the UK national clinical audit for in-hospital cardiac arrest: the National Cardiac Arrest Audit (NCAA).6 The aim of NCAA is to promote improvements in resuscitation care and outcomes through the provision of timely, validated comparative data to participating hospitals. The aim of this analysis is to report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the UK National Cardiac Arrest Audit database.

Section snippets

The National Cardiac Arrest Audit

NCAA is a subscription-based, national clinical audit of patients greater than 28 days of age in acute hospitals in the UK who receive cardiopulmonary resuscitation (CPR) following an in-hospital cardiac arrest and are attended by the hospital-based resuscitation team (or equivalent) in response to a 2222 call (2222 is the emergency telephone number used to summon a resuscitation team in UK hospitals; Fig. 1). CPR is defined by NCAA as the receipt of chest compressions and/or defibrillation.

Results

A total of 144 acute hospitals contributed data from the period 1st April 2011 to 31st March 2013. Due to hospitals joining NCAA at different times, individual hospital participation ranged from 2 to 24 months. Overall, 23,554 in-hospital cardiac arrests were reported for 22,628 patients (range 0–665 cardiac arrests for individual hospitals). The total number of hospital admissions for this period was 14,784,144, giving an overall incidence of adult in-hospital cardiac arrest, attended by a

Discussion

In 144 UK acute hospitals for the period 1st April 2011 to 31st March 2013, the overall incidence of adult in-hospital cardiac arrest, attended by a hospital-based resuscitation team, was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (IQR 1.2–2.2). Overall unadjusted survival to hospital discharge was 18.4%. Presenting rhythm was shockable (VF/VT) for 16.9% and non-shockable (asystole/PEA) for 72.3%; rates of survival to hospital discharge associated with these rhythms

Conclusion

These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest. The development and validation of a risk model will enable more meaningful comparisons across hospitals, between patient groups, and over time.11 Inclusion of the patient's National Health Service (NHS)

Conflict of interest statement

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that JPN, JS, GBS, CG, FP, SP, DH, EN and KR have no non-financial interests that may be relevant to the submitted work. JPN is Editor-in-Chief of Resuscitation. JS is an Editor for Resuscitation.

Authors contribution

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. JPN is responsible for the overall content as guarantor.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.04.002.

1

See Appendix A for Members of the National Cardiac Arrest Audit Steering Group.

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