Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest

Abstract

Purpose

To improve cardiac arrest survival, international resuscitation guidelines emphasize measuring the quality of cardiopulmonary resuscitation (CPR). We aimed to investigate CPR quality during in-hospital cardiac arrest (IHCA) and study long-term survival outcomes.

Patients and Methods

This was a cohort study of IHCA from December 2011 until November 2014. Data were collected from the hospital switch board, patient records, and from defibrillators. Impedance data from defibrillators were analyzed manually at the level of single compressions. Long-term survival at 1-, 3-, and 5 years is reported.

Results

The study included 189 IHCAs; median (interquartile range (IQR)) time to first rhythm analysis was 116 (70–201) seconds and median (IQR) time to first defibrillation was 133 (82–264) seconds. Median (IQR) chest compression rate was 126 (119–131) per minute and chest compression fraction (CCF) was 78% (69–86). Thirty-day survival was 25%, while 1-year-, 3-year-, and 5-year survival were 21%, 14%, and 13%, respectively. There was no significant association between any survival outcomes and CCF, whereas chest compression rate was associated with survival to 30 days and 3 years. Overall, 5-year survival was associated with younger age (median 68 vs 74 years, p=0.003), less comorbidity (Charlson comorbidity index median 3 vs 5, p<0.001), and witnessed cardiac arrest (96% vs 77%, p=0.03).

Conclusion

We established a systematic collection of IHCA CPR quality data to measure and improve CPR quality and long-term survival outcomes. Median time to first rhythm check/defibrillation was <3 minutes, but median chest compression rate was too fast and median CCF slightly below 80%. More than half of 30-day survivors were still alive at 5 years.

Keywords:

• in-hospital cardiac arrest
• transthoracic impedance
• long-term survival
• chest compression rate
• chest compression fraction

Funding

This work was funded by The South Denmark Region Research Foundation (grant number 13/6968), The Hede-Nielsen Foundation and The Development Council and The Chief Physicians Council, Lillebaelt Hospital, Vejle. The funding sources had no influence on the conduct of the research, the preparation of the article, the collection, analysis, and interpretation of data, or in the writing of the article.

Disclosure

The authors report no conflicts of interest in this work.