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Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation
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Nolan, J. P., Ferrando, P., Soar, J., Benger, J., Thomas, M., Harrison, D. A. and Perkins, Gavin D. (2016) Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation. Critical Care, 20 (1). 219. doi:10.1186/s13054-016-1390-6 ISSN 1466-609X.
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Official URL: http://dx.doi.org/10.1186/s13054-016-1390-6
Abstract
Background
In recent years there have been many developments in post-resuscitation care. We have investigated trends in patient characteristics and outcome following admission to UK critical care units following cardiopulmonary resuscitation (CPR) for the period 2004–2014. Our hypothesis is that there has been a reduction in risk-adjusted mortality during this period.
Methods
We undertook a prospectively defined, retrospective analysis of the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database (CMPD) for the period 1 January 2004 to 31 December 2014. Admissions, mechanically ventilated in the first 24 hours in the critical care unit and admitted following CPR, defined as the delivery of chest compressions in the 24 hours before admission, were identified. Case mix, withdrawal, outcome and activity were described annually for all admissions identified as post-cardiac arrest admissions, and separately for out-of-hospital cardiac arrest and in-hospital cardiac arrest. To assess whether in-hospital mortality had improved over time, hierarchical multivariate logistic regression models were constructed, with in-hospital mortality as the dependent variable, year of admission as the main exposure variable and intensive care unit (ICU) as a random effect. All analyses were repeated using only the data from those ICUs contributing data throughout the study period.
Results
During the period 2004–2014 survivors of cardiac arrest accounted for an increasing proportion of mechanically ventilated admissions to ICUs in the ICNARC CMPD (9.0 % in 2004 increasing to 12.2 % in 2014). Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during this period (OR 0.96 per year). Over this time, the ICU length of stay and time to treatment withdrawal has increased significantly. Re-analysis including only those 116 ICUs contributing data throughout the study period confirmed all the results of the primary analysis.
Conclusions
Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during the period 2004–2014. Over the same period the ICU length of stay and time to treatment withdrawal has increased significantly.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit | ||||||
| Library of Congress Subject Headings (LCSH): | Cardiac resuscitation, Intensive care units | ||||||
| Journal or Publication Title: | Critical Care | ||||||
| Publisher: | BioMed Central Ltd. | ||||||
| ISSN: | 1466-609X | ||||||
| Official Date: | 9 July 2016 | ||||||
| Dates: |
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| Volume: | 20 | ||||||
| Number: | 1 | ||||||
| Article Number: | 219 | ||||||
| DOI: | 10.1186/s13054-016-1390-6 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 20 April 2017 | ||||||
| Date of first compliant Open Access: | 21 April 2017 |
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