WASHINGTON (Jan 22, 2018) - Overall survival has improved for the approximately 200,000 patients experiencing in-hospital cardiac arrest in the U.S. each year, but patients who arrest during nights or weekends continue to experience lower survival compared to patients who arrest during daytime hours. Survival to discharge in patients who arrested during "off-hours" was an absolute 3.8 percent lower compared to patients who arrested during "on-hours," according to a study published today in the Journal of the American College of Cardiology.

Surviving in-hospital cardiac arrest depends on early recognition and implementation of resuscitation, as well as high-quality post-resuscitation care. A previous study found rates of survival and neurological outcomes were 15 to 20 percent lower among patients who arrested during nights or weekends (off-hours). Researchers for this study sought to determine how survival differences have changed over time in patients who arrest during on-hours vs. off-hours. On-hours was categorized as 7:00 a.m. to 10:59 p.m. Monday to Friday. Off-hours was described as 11:00 p.m. to 6:59 a.m. Monday to Friday or anytime on weekends.

"Nearly 50 percent of in-hospital cardiac arrests take place during 'off-hours.' By determining how survival has changed in recent years, we may be able to identify opportunities for quality improvement efforts," said lead author Uchenna R. Ofoma, MD, MS, attending physician with the division of critical care medicine at Geisinger Health System in Danville, Pennsylvania. "If we can improve survival for cardiac arrests that occur during off-hours, it could impact a substantial number of patients."
Researchers identified 151,071 patients at least 18 years old who experienced in-hospital cardiac arrest between January 2000 and December 2014 using the GWTG-Resuscitation registry. More than half of the included patients experienced cardiac arrest during off-hours; overall, 62.4 percent of patients survived acute resuscitation efforts and 18.6 percent survived to hospital discharge. Both on- and off-hours groups had a similar prevalence of co-morbidities, location of arrest and interventions in place at time of arrest.

Overall, survival to discharge increased in both groups over the 15-year study period—for on-hours: from 16 percent in 2000 to 25.2 percent in 2014; for off-hours: 11.9 percent in 2000 to 21.9 percent in 2014. However, the survival during off-hours remained significantly lower compared to on-hours.

Cardiology Homepage