Abstract 264: Timing of In-Hospital Cardiac Arrest and Association with Survival to Discharge and Subsequent Length of Stay

Background: In-hospital cardiac arrest (IHCA) is common and often fatal. To date, the time from admission to IHCA has not been described, and the association between timing of cardiac arrest and likelihood of survival to discharge and subsequent hospital length of stay (LOS) is unknown. Methods: Within the national Get with the Guidelines Resuscitation registry, we identified 175,904 patients admitted between 2000 and 2013 with an IHCA. For each patient, the time from admission to IHCA was determined and categorized as early (7 days). Multivariable hierarchical logistic regression models examined the association between timing of IHCA and both survival to discharge and, among survivors, subsequent LOS from date of IHCA. Results: Overall, the mean and median times from admission to IHCA were 5.3 ± 6.3 days and 3 days (IQR: 1-8), respectively. Nearly half (83,811 [47.6%]) of patients had their IHCA 7 days from admission, respectively. After adjustment for patient and and cardiac arrest factors, cardiac arrests occurring later during the hospitalization were associated with modestly lower survival (reference: 7 days: adjusted OR 0.89 [0.86-0.92]; P<.01). However, this association pertained only to patients with a shockable IHCA (P for interaction between shockable and non-shockable rhythms: <0.001). Lastly, among those surviving to discharge, later timing of IHCA was associated with much longer subsequent LOS (reference: 7 days: 6.8 additional days [6.3-7.3]; P<0.001). Conclusion: Most IHCA occur after the first 72 hours of admission. Patients with IHCA >3 days from admission had significantly lower hospital survival and longer hospitalizations from the time of cardiac arrest.