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Aim: This study investigated the changes in quality of life (QOL) after in-hospital cardiopulmonary arrest (IHCA) among survivors and examined the association between worsening QOL and 3-year all-cause mortality.Methods: This population-based cohort study used data from the National Health Insurance Service database in South Korea. Adult survivors who experienced IHCA between January 1, 2010, and December 31, 2018, and were alive for over 1 year after IHCA were included. Worsening QOL among IHCA survivors was determined using three criteria: decreased household income, unemployment, and acquired disability.Results: A total of 22,611 IHCA survivors from 903 hospitals were included in the final analysis, and 7,796 (34.5%) experienced worsening QOL. Specifically, 5,595 (24.7%), 1,694 (7.5%), and 1,617 (7.2%) survivors experienced decreased household income, unemployment, and acquired disability, respectively. The proportion of brain lesion disability increased from 6.3% to 10.8% after IHCA. In multivariable Cox regression, worsening QOL was not associated with 3-year all-cause mortality (adjusted hazard ratio [aHR]: 1.03, 95% confidence interval [CI]: 0.96, 1.11; P = 0.372). However, among the QOL factors, acquired disability was associated with a 1.29-fold higher risk of 3-year all-cause mortality among IHCA survivors (aHR: 1.29, 95% CI: 1.15, 1.46; P < 0.001).Conclusion: Approximately one-third of IHCA survivors experienced worsening QOL (decreased household income, unemployment, and acquired disability) at 1-year follow-up after IHCA in South Korea. Although overall worsening of QOL was not associated with 3-year all-cause mortality, acquired disability was associated with increased 3-year all-cause mortality among IHCA survivors. [ABSTRACT FROM AUTHOR]

Backgrounds: In-Hospital Cardiac Arrest (IHCA) requires the preparation of considerable medical resources in hospitals. Furthermore, compared to Out-of-Hospital Cardiac Arrest, until recently, there have not been many studies on the incidence, characteristics, and prognosis of IHCA. This study is to examine IHCA event rates among hospitalized patients in the Republic of Korea from 2011 to 2015. Methods: The incidence of IHCA in adults was extracted from claim data of the National Health Insurance Service from 2011 to 2015, and analyzed according to age, sex, the classification under the 7th revision of the Korean Standard Classification of Diseases (KCD-7), hospital types, and provinces. Results: From 2011 to 2015, the overall incidence of IHCA in Korea was founded to be 3.00 per 1,000 hospitalizations. The overall 5-year IHCA incidence was higher in male at 3.92 cases per 1,000 hospitalizations and at female 2.19 cases per 1,000 hospitalizations. Incidence due to cardiovascular disease increased year by year, whereas incidences due to respiratory, neurological and infectious disease were decreasing, and in the case of oncologic disease, there was no change. In particular, patients with diseases of the circulatory system had at least a two times higher incidence compared to those with other diseases. The IHCA incidence in general hospitals and tertiary hospitals was at least twofold higher than the national overall and showed an increasing trend. The provinces that showed a higher IHCA incidence than the five-year national overall were Jeju Special Self-Governing Province, Gangwon Province, and Seoul. Conclusions: The results of this study can be used as important basic data to secure patient safety by reducing the occurrence of IHCA. [ABSTRACT FROM AUTHOR]

Background: Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, the association between emergency department crowding and the occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and the incidence of in-hospital cardiac arrest.Methods: A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at the time of presentation of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is the association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates.Results: During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality.Conclusion: Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are few studies of the epidemiology and clinical outcomes of patients with in-hospital cardiac arrest (IHCA) in a general hospital ward. OBJECTIVE: To investigate the clinical outcomes of IHCA cases that occurred in the general ward of a university hospital and that were witnessed and/or monitored. METHODS: We prospectively gathered data on all IHCAs in the general ward of Asan Medical Center, Seoul, South Korea, that were recorded by the Medical Emergency Team between March 2008 and February 2010. The main outcomes included survival to hospital discharge, incidence of IHCA, and prognostic factors related to hospital mortality. We also investigated preventable cases. RESULTS: We identified 238 index cases of IHCA. The average incidence of IHCA was 0.145 IHCAs per 1,000 patient admissions. Survival to hospital discharge was 19% (46 cases), 66% of which were due to non-cardiac causes, and 77% were due to medical illnesses. The most common first documented rhythm was pulseless electrical activity (38%). Two hundred three cases (85.3%) of IHCA were witnessed at the event; 135 cases (56.7%) were monitored at the event. Non-witnessed cases, monitored cases, night onset, medical illness, metastatic cancer, intubation, and long duration of cardiopulmonary resuscitation were significantly associated with hospital mortality. We identified 91 preventable cases (38%). Respiratory insufficiency (37 cases, 41%) was one of major cause of preventable IHCA. CONCLUSIONS: Witnessed IHCAs in the general ward had a higher rate of survival to hospital discharge; however, monitored cases had a lower rate of survival to hospital discharge. Respiratory insufficiency was a major preventable cause of IHCA. In consideration of the preventable IHCAs, further studies should be performed on monitoring practices in general wards. [ABSTRACT FROM AUTHOR]

This study was to determine whether prolonged emergency department (ED) length of stay (LOS) is associated with increased risk of in-hospital cardiac arrest (IHCA). A retrospective cohort with a nationwide database of all adult patients who visited the EDs in South Korea between January 2016 and December 2017 was performed. A total of 18,217,034 patients visited an ED during the study period. The median ED LOS was 2.5 h. IHCA occurred in 9,180 patients (0.2%). IHCA was associated with longer ED LOS (4.2 vs. 2.5 h), and higher rates of intensive care unit (ICU) admission (58.6% vs. 4.7%) and in-hospital mortality (35.7% vs. 1.5%). The ED LOS correlated positively with the development of IHCA (Spearman ρ = 0.91; p < 0.01) and was an independent risk factor for IHCA (odds ratio (OR) 1.10; 95% confidence interval (CI), 1.10–1.10). The development of IHCA increased in a stepwise fashion across increasing quartiles of ED LOS, with ORs for the second, third, and fourth relative to the first being 3.35 (95% CI, 3.26–3.44), 3.974 (95% CI, 3.89–4.06), and 4.97 (95% CI, 4.89–5.05), respectively. ED LOS should be reduced to prevent adverse events in patients visiting the ED. [ABSTRACT FROM AUTHOR]