The chain of survival for in-hospital cardiac arrest: Improving systems of care

In-hospital cardiac arrest (IHCA) is a devastating event that can happen to any hospitalized patient. The global incidence of IHCA is poorly described and the disease remains difficult to treat. 1 Andersen L.W. Holmberg M.J. Berg K.M. Donnino M.W. Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019; 321: 1200-1210https://doi.org/10.1001/jama.2019.1696 Crossref PubMed Scopus (378) Google Scholar , 2 Sandroni C. Nolan J. Cavallaro F. Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007; 33 (Epub 2006 Sep 22 PMID: 17019558): 237-245https://doi.org/10.1007/s00134-006-0326-z Crossref PubMed Scopus (467) Google Scholar , 3 Morrison L.J. Neumar R.W. Zimmerman J.L. et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation. 2013; 127 (Epub 2013 Mar 11 PMID: 23479672): 1538-1563https://doi.org/10.1161/CIR.0b013e31828b2770 Crossref PubMed Scopus (211) Google Scholar A systematic review of randomized controlled cardiac arrest trials found that only four studies in the last twenty years focused exclusively on an IHCA cohort, with only one additional study focusing on both IHCA and out-of-hospital cardiac arrest (OHCA). 4 Sinha S.S. Sukul D. Lazarus J.J. et al. Identifying Important Gaps in Randomized Controlled Trials of Adult Cardiac Arrest Treatments: A Systematic Review of the Published Literature. Circ Cardiovasc Qual Outcomes. 2016; 9 (Epub 2016 Oct 18. PMID: 27756794; PMCID: PMC5339040): 749-756https://doi.org/10.1161/CIRCOUTCOMES.116.002916 Crossref PubMed Scopus (42) Google Scholar While improvements in survival from IHCA are ongoing, it continues to be understudied in comparison to OHCA. 5 Girotra S. Nallamothu B.K. Spertus J.A. Li Y. Krumholz H.M. Chan P.S. American Heart Association Get with the Guidelines-Resuscitation Investigators. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367 (PMID: 23150959; PMCID: PMC3517894): 1912-1920https://doi.org/10.1056/NEJMoa1109148 Crossref PubMed Scopus (606) Google Scholar IHCA is largely managed by the Rapid Response Team (RRT) model. While variable between institutions, the RRT model generally comprises of critical care physicians, intensive care unit or dedicated rapid response nursing, respiratory therapists, and other house staff who respond to a broad number of clinical conditions including cardiac arrests. 6 Jones D.A. DeVita M.A. Bellomo R. Rapid-response teams. N Engl J Med. 2011; 365 (PMID: 21751906): 139-146https://doi.org/10.1056/NEJMra0910926 Crossref PubMed Scopus (524) Google Scholar While the RRT model represents an efficient method to mobilize care for IHCA, the ideal system for treatment of IHCA remains unknown. Studies investigating changes to the local practice of Rapid Response Teams are one way to understand the most ideal practices for treating IHCA.