Chan ML, et al. - Researchers studied the prognosis and end-of-life decision-making patterns of a patient with a recurrent in-hospital cardiac arrest (IHCA). A recurrent IHCA was detected in nearly 1 in 8 patients with an IHCA. Worse outcomes were observed in these patients, relative to those seen in patients with only a single IHCA and those with an IHCA after being hospitalized for an out-of-hospital cardiac arrest (OHCA). For patients with recurrent IHCA, worse survival was reported, however, rates of do-not-attempt-resuscitate (DNAR) and withdrawal of care were lowest. There is a need to better align resuscitation and end-of-life decisions with patients' prognoses after IHCA.

Methods

• Within Get-With-The-Guidelines-Resuscitation, researchers identified 192,250 patients from 711 hospitals with an IHCA from 2000–2015.
• They divided patients into 3 groups: having no recurrent IHCA (only 1 event), recurrent IHCA (≥2 IHCAs), and recurrent out-of-hospital cardiac arrest (OHCA), defined as an IHCA after an OHCA.
• They used multivariable hierarchical logistic regression to compare the 3 groups in terms of rates of survival to discharge and favorable neurological survival (mild or no disability).
• They also assessed rates of de novo Do-Not-Attempt-Resuscitate (DNAR) and withdrawal of care orders among successfully resuscitated patients.

Results

• As per data, 165,446 (86.1%) had no recurrent IHCA, 23,643 (12.3%) had recurrent IHCA, and 3162 (1.6%) had recurrent OHCA.
• Researchers found that patients with recurrent IHCA vs patients with no recurrent IHCA were less than half as likely to survive to discharge (12.7% vs 22.1%; adjusted OR: 0.46 [0.44, 0.48] P < .001) and have favorable neurological survival (7.0% vs 13.1%; adjusted OR: 0.44 [0.42, 0.47] P< .001).
• Patients with recurrent IHCA also had lower rates of survival to discharge (12.7% vs 16.1%; adjusted OR: 0.81 [0.71, 0.94] P=.005) and favorable neurological survival (7.0% vs 8.9%; adjusted OR: 0.66 [0.54, 0.81] P < .001) vs patients with recurrent OHCA.
• Worse survival outcomes were reported in patients with recurrent IHCA, but these patients were least likely to adopt DNAR orders within the first 24 hours after successful resuscitation vs those with no recurrent IHCA or recurrent OHCA (17.2% vs 18.9% and 26.6%, respectively) or withdraw care at any time (17.7% vs 24.4% and 31.2%, respectively).