Table 1.
A. Patient characteristics, stratified by quintiles of hospital cardiac arrest incidence rates
| Quintiles of Cardiac Arrest Incidence Rates
|
||||||
|---|---|---|---|---|---|---|
| Very Low | Low | Average | High | Very High | ||
| (n = 10702) | (n = 17321) | (n = 19686) | (n = 22833) | (n = 31611) | P-Value* | |
| (N = 71) | (N = 72) | (N = 71) | (N = 72) | (N = 72) | ||
|
| ||||||
| Cardiac Arrest Incidence Rates, % | 0.9 to <2.8 | 2.8 to <3.5 | 3.5 to <4.6 | 4.6 to <6.1 | 6.1 to 18.4 | |
| Patient Characteristics | ||||||
| Demographics | ||||||
| Age | 0.07 | |||||
| Mean ± SD | 66.0 ± 16.0 | 66.4 ± 15.7 | 66.3 ± 16.2 | 66.7 ± 15.5 | 65.5 ± 15.9 | |
| Median (IQR) | 68.0 (56.0, 78.0) | 69.0 (56.0, 79.0) | 69.0 (56.0, 79.0) | 69.0 (57.0, 78.0) | 67.0 (55.0, 78.0) | |
| Sex | 0.053 | |||||
| Male | 6340 (59.2) | 9953 (57.5) | 11378 (57.8) | 12971 (56.8) | 18812 (59.5) | |
| Female | 4361 (40.8) | 7368 (42.5) | 8308 (42.2) | 9862 (43.2) | 12799 (40.5) | |
| Race | < 0.001 | |||||
| White | 7398 (80.9) | 12138 (78.0) | 15023 (80.6) | 16833 (77.4) | 19728 (65.7) | |
| Black | 1221 (13.4) | 2616 (16.8) | 2866 (15.4) | 4413 (20.3) | 8979 (29.9) | |
| Other | 527 (5.8) | 817 (5.2) | 747 (4.0) | 494 (2.3) | 1302 (4.3) | |
| Pre-Existing Conditions | ||||||
| Heart failure this admission | 1704 (15.9) | 2757 (15.9) | 3308 (16.8) | 4872 (21.3) | 5980 (18.9) | < 0.001 |
| Heart failure prior to admission | 2264 (21.2) | 3448 (19.9) | 4110 (20.9) | 5429 (23.8) | 6611 (20.9) | 0.002 |
| MI/ischemia this admission | 1657 (15.5) | 3103 (17.9) | 3698 (18.8) | 4738 (20.8) | 5751 (18.2) | < 0.001 |
| MI/ischemia prior to admission | 1730 (16.2) | 2779 (16.0) | 3753 (19.1) | 4442 (19.5) | 4987 (15.8) | 0.90 |
| Arrhythmia | 3409 (31.9) | 5693 (32.9) | 6635 (33.7) | 8087 (35.4) | 10669 (33.8) | < 0.001 |
| Hypotension/hypoperfusion | 3029 (28.3) | 4533 (26.2) | 5632 (28.6) | 6701 (29.3) | 9200 (29.1) | < 0.001 |
| Respiratory insufficiency | 4068 (38.0) | 6818 (39.4) | 8541 (43.4) | 9501 (41.6) | 14060 (44.5) | < 0.001 |
| Renal insufficiency | 3275 (30.6) | 5555 (32.1) | 6256 (31.8) | 7669 (33.6) | 11051 (35.0) | < 0.001 |
| Hepatic insufficiency | 750 (7.0) | 1187 (6.9) | 1538 (7.8) | 1615 (7.1) | 2617 (8.3) | < 0.001 |
| Metabolic/electrolyte abnormality | 1653 (15.4) | 2892 (16.7) | 3639 (18.5) | 4207 (18.4) | 5376 (17.0) | 0.001 |
| Diabetes mellitus | 2973 (27.8) | 5134 (29.6) | 5623 (28.6) | 7280 (31.9) | 9772 (30.9) | < 0.001 |
| Baseline depression in CNS function | 1267 (11.8) | 1817 (10.5) | 2559 (13.0) | 3069 (13.4) | 4501 (14.2) | < 0.001 |
| Acute stroke | 403 (3.8) | 600 (3.5) | 855 (4.3) | 884 (3.9) | 1353 (4.3) | < 0.001 |
| Acute CNS non-stroke event | 873 (8.2) | 1141 (6.6) | 1443 (7.3) | 2151 (9.4) | 2702 (8.5) | < 0.001 |
| Pneumonia | 1245 (11.6) | 2180 (12.6) | 2351 (11.9) | 3257 (14.3) | 4613 (14.6) | < 0.001 |
| Septicemia | 1464 (13.7) | 2534 (14.6) | 3138 (15.9) | 3403 (14.9) | 5413 (17.1) | < 0.001 |
| Major trauma | 453 (4.2) | 500 (2.9) | 891 (4.5) | 730 (3.2) | 1511 (4.8) | < 0.001 |
| Metastatic/hematologic malignancy | 1316 (12.3) | 2141 (12.4) | 2539 (12.9) | 2550 (11.2) | 4005 (12.7) | 0.84 |
| Interventions in Place† | ||||||
| Assisted/mechanical ventilation | 2700 (25.2) | 4735 (27.3) | 6249 (31.7) | 6761 (29.6) | 10399 (32.9) | < 0.001 |
| Invasive airway | 2755 (25.8) | 4560 (26.3) | 6089 (30.9) | 6440 (28.2) | 10637 (33.7) | < 0.001 |
| Pacemaker | 679 (6.3) | 1161 (6.7) | 1357 (6.9) | 1694 (7.4) | 2152 (6.8) | 0.050 |
| IV/IO antiarrhythmics | 611 (5.7) | 1013 (5.8) | 1358 (6.9) | 1222 (5.4) | 1750 (5.5) | 0.01 |
| IV/IO vasoactive agents | 2583 (24.2) | 4494 (25.9) | 5583 (28.4) | 5928 (26.0) | 9021 (28.5) | < 0.001 |
| Dialysis/extracorporeal filtration | 354 (3.3) | 603 (3.5) | 885 (4.5) | 683 (3.0) | 1406 (4.4) | < 0.001 |
|
B. Event characteristics, stratified by quintiles of hospital cardiac arrest incidence rates
| ||||||
| Event Characteristics | ||||||
| Admission year | < 0.001 | |||||
| 2000 | 147 (1.4) | 150 (0.9) | 316 (1.6) | 470 (2.1) | 751 (2.4) | |
| 2001 | 629 (5.9) | 885 (5.1) | 1226 (6.2) | 1361 (6.0) | 1157 (3.7) | |
| 2002 | 1015 (9.5) | 1561 (9.0) | 1836 (9.3) | 2220 (9.7) | 2165 (6.9) | |
| 2003 | 1272 (11.9) | 2267 (13.1) | 2185 (11.1) | 2777 (12.2) | 3317 (10.5) | |
| 2004 | 1374 (12.9) | 2209 (12.8) | 2347 (11.9) | 2911 (12.8) | 3883 (12.3) | |
| 2005 | 1294 (12.1) | 2229 (12.9) | 2760 (14.0) | 2887 (12.6) | 4137 (13.1) | |
| 2006 | 1488 (13.9) | 2350 (13.6) | 2444 (12.4) | 2614 (11.5) | 4119 (13.0) | |
| 2007 | 1367 (12.8) | 1766 (10.2) | 2478 (12.6) | 2842 (12.5) | 4512 (14.3) | |
| 2008 | 1334 (12.5) | 2181 (12.6) | 2604 (13.2) | 2841 (12.4) | 4491 (14.2) | |
| 2009 | 763 (7.1) | 1709 (9.9) | 1465 (7.5) | 1900 (8.3) | 3070 (9.7) | |
| Night | 3421 (32.5) | 5735 (33.5) | 6352 (32.6) | 7251 (32.2) | 10006 (32.0) | 0.01 |
| Location | < 0.001 | |||||
| ICU | 4873 (45.6) | 8164 (47.2) | 9640 (49.0) | 10074 (44.1) | 15001 (47.5) | |
| Monitored unit | 1576 (14.7) | 2974 (17.2) | 2851 (14.5) | 3642 (16.0) | 4489 (14.2) | |
| Non-monitored unit | 2288 (21.4) | 3184 (18.4) | 3549 (18.1) | 4393 (19.2) | 5632 (17.8) | |
| Emergency | 1057 (9.9) | 1597 (9.2) | 1833 (9.3) | 2583 (11.3) | 3813 (12.1) | |
| Others | 902 (8.4) | 1395 (8.1) | 1789 (9.1) | 2137 (9.4) | 2659 (8.4) | |
| Weekend | 3297 (30.8) | 5398 (31.2) | 6092 (30.9) | 7005 (30.7) | 9757 (30.9) | 0.65 |
| Hospital-wide response activated | 8773 (82.0) | 14171 (81.8) | 15743 (80.0) | 17751 (77.7) | 23429 (74.1) | < 0.001 |
| Compressions | 10345 (96.7) | 16807 (97.0) | 19200 (97.5) | 22154 (97.0) | 30668 (97.0) | 0.55 |
| Automated External Defibrillator applied | < 0.001 | |||||
| Yes | 1466 (13.7) | 1835 (10.6) | 1696 (8.6) | 2712 (11.9) | 3986 (12.6) | |
| No/none | 9236 (86.3) | 15486 (89.4) | 17987 (91.4) | 20121 (88.1) | 27625 (87.4) | |
| Initial Rhythm | < 0.001 | |||||
| Asystole | 3762 (35.2) | 6053 (34.9) | 7264 (36.9) | 8027 (35.2) | 11829 (37.4) | |
| PEA | 4215 (39.4) | 7115 (41.1) | 8045 (40.9) | 9704 (42.5) | 13239 (41.9) | |
| VF | 1816 (17.0) | 2638 (15.2) | 2800 (14.2) | 3269 (14.3) | 4202 (13.3) | |
| PVT | 909 (8.5) | 1515 (8.7) | 1577 (8.0) | 1833 (8.0) | 2341 (7.4) | |
| Defibrillation/shock provided | 4322 (91.6) | 6922 (92.2) | 7664 (94.0) | 8855 (94.1) | 11909 (93.0) | < 0.001 |
| Cerebral Perfusion Category† | < 0.001 | |||||
| 1 | 5381 (57.1) | 8572 (57.1) | 7710 (47.9) | 10636 (51.3) | 12509 (48.4) | |
| 2 | 2443 (25.9) | 3895 (26.0) | 5172 (32.1) | 5987 (28.9) | 7381 (28.5) | |
| 3 | 1111 (11.8) | 1668 (11.1) | 2153 (13.4) | 2725 (13.1) | 3925 (15.2) | |
| 4 | 488 (5.2) | 869 (5.8) | 1062 (6.6) | 1393 (6.7) | 2038 (7.9) | |
|
C. Hospital characteristics, stratified by quintiles of hospital cardiac arrest incidence rates
| ||||||
| Hospital Characteristics | ||||||
| Teaching status | 0.98 | |||||
| Major teaching | 18 (25.4) | 16 (22.2) | 16 (22.5) | 12 (16.7) | 21 (29.2) | |
| Minor teaching | 21 (29.6) | 25 (34.7) | 22 (31.0) | 21 (29.2) | 22 (30.6) | |
| Non-teaching | 32 (45.1) | 31 (43.1) | 33 (46.5) | 39 (54.2) | 29 (40.3) | |
| Member of Council of Teaching Hospitals | 18 (25.4) | 16 (22.2) | 16 (22.5) | 12 (16.7) | 21 (29.2) | 0.89 |
| Trauma center | 0.36 | |||||
| No | 31 (43.7) | 27 (37.5) | 27 (38.0) | 36 (50.0) | 27 (37.5) | |
| Yes | 33 (46.5) | 42 (58.3) | 41 (57.7) | 29 (40.3) | 32 (44.4) | |
| Unknown | 7 (9.9) | 3 (4.2) | 3 (4.2) | 7 (9.7) | 13 (18.1) | |
| Ownership | 0.03 | |||||
| Non-Profit | 56 (78.9) | 54 (75.0) | 52 (73.2) | 52 (72.2) | 43 (59.7) | |
| Public | 10 (14.1) | 9 (12.5) | 7 (9.9) | 12 (16.7) | 17 (23.6) | |
| Private | 5 (7.0) | 9 (12.5) | 12 (16.9) | 8 (11.1) | 12 (16.7) | |
| Region | 0.93 | |||||
| North and Mid-Atlantic | 15 (21.1) | 11 (15.3) | 10 (14.1) | 6 (8.3) | 6 (8.3) | |
| South and Atlantic | 12 (16.9) | 20 (27.8) | 19 (26.8) | 23 (31.9) | 22 (30.6) | |
| North Central | 15 (21.1) | 17 (23.6) | 16 (22.5) | 21 (29.2) | 10 (13.9) | |
| South Central | 7 (9.9) | 13 (18.1) | 12 (16.9) | 13 (18.1) | 25 (34.7) | |
| Mountain/Pacific | 22 (31.0) | 11 (15.3) | 14 (19.7) | 9 (12.5) | 9 (12.5) | |
| Urban | 64 (90.1) | 69 (95.8) | 63 (88.7) | 61 (84.7) | 68 (94.4) | 0.82 |
| Full-time equivalent nurse ratio | 0.02 | |||||
| <1.5 | 22 (31.0) | 19 (26.4) | 28 (39.4) | 40 (55.6) | 31 (43.1) | |
| 1.5<2 | 26 (36.6) | 30 (41.7) | 18 (25.4) | 14 (19.4) | 23 (31.9) | |
| 2-<2.5 | 14 (19.7) | 17 (23.6) | 18 (25.4) | 13 (18.1) | 13 (18.1) | |
| 2.5+ | 9 (12.7) | 6 (8.3) | 7 (9.9) | 5 (6.9) | 5 (6.9) | |
| Number of beds | 0.03 | |||||
| <200 | 13 (18.3) | 13 (18.1) | 17 (23.9) | 15 (20.8) | 19 (26.4) | |
| 200-349 | 23 (32.4) | 24 (33.3) | 19 (26.8) | 35 (48.6) | 26 (36.1) | |
| 350-499 | 15 (21.1) | 18 (25.0) | 15 (21.1) | 11 (15.3) | 13 (18.1) | |
| 500+ | 20 (28.2) | 17 (23.6) | 20 (28.2) | 11 (15.3) | 14 (19.4) | |
| Case mix index | 0.15 | |||||
| Mean ± SD | 1.5 ± 0.2 | 1.5 ± 0.2 | 1.6 ± 0.2 | 1.5 ± 0.3 | 1.6 ± 0.2 | |
| Median (IQR) | 1.5 (1.3, 1.7) | 1.5 (1.4, 1.7) | 1.5 (1.4, 1.7) | 1.5 (1.3, 1.6) | 1.6 (1.4, 1.7) | |
Abbreviations: N is number of hospitals; n is number of patients; SD is standard deviation; IQR is interquartile range; MI is myocardial infarction; CNS is central nervous system; IV/IO is intravenous/intraosseous
*
Continuous variables compared using linear trend test. Categorical variables compared using Mantel-Haenszel trend test
†
Interventions in Place refers to interventions already in place when need for chest compressions and/or defibrillation first recognized
Abbreviations: N is number of hospitals; n is number of patients; SD is standard deviation; IQR is interquartile range; ICU is intensive care unit; PEA is pulseless electrical activity; VF is ventricular fibrillation; PVT is pulseless ventricular tachycardia; ROSC is return of spontaneous circulation
†
Cerebral perfusion category (on admission) definitions: 1 is good cerebral performance, 2 is moderate cerebral disability, 3 is severe cerebral disability, 4 is coma or vegetative state, and 5 is brain death
Abbreviations: N is number of hospitals; n is number of patients; SD is standard deviation; IQR is inter-quartile range