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

Lone Due Vestergaard,1 Kasper Glerup Lauridsen,2,3 Niels Henrik Vinther Krarup,4 Jane Uhrenholt Kristensen,1 Lone Kaerslund Andersen,1 Bo Løfgren2,3,5 1Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark; 2Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; 3Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; 4Cardiologist in Private Practice, Hjerteklinik Midt, Aarhus, Denmark; 5Department of Clinical Medicine, Aarhus University, Aarhus, DenmarkCorrespondence: Lone Due VestergaardDepartment of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, 7100, DenmarkTel +45 25329737Email ldue@hotmail.comPurpose: 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