Predictors of in hospital outcome after cardiopulmonary resuscitation due to in hospital cardiac arrest

Despite possible differences between out of hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) populations, most available data is taken from analyses of OHCA patients (pts). More data about predictors of return of spontaneous circulation (ROSC) and in-hospital mortality after IHCA is needed. For example, a high serum lactate is frequent in OHCA patients and is associated with poor outcome. However, little is known about its possible effect in patients after IHCA.

To investigate the incidence of specefic parameters and their probable influence on in-hospital outcome in pts after cardiopulmonary resuscitation (CPR) due to IHCA.

Design: We retrospectively analyzed 145 consecutive nontraumatic pts who were between 2021 and 2022 cardiopulmonary resuscitated at our center. We separated them into two groups (OHCA and IHCA) and compared them regarding in-hospital outcomes.

Baseline characteristics are listed in table 1. ROSC occurred in 86 pts (59.3%). In-hospital mortality rate was 71.1% (103 pts). This was comparable in both groups (69.1% in the IHCA group and 76.5% in the OHCA group, p 0.410). Neurologic injury was described in 2 pts (both from the OHCA group, p 0.354). A serum lactate level >100mg/dl at baseline (defined as less than two hours after CPR onset) was associated with high mortality in both groups (however, it was statistically significant only in the IHCA group; p <0.001 and 0.063 respectively). Whereas the same high level of serum lactate 2 hours after CPR onset, was associated with a high statistically significant mortality in both groups (p 0.002 and 0.012). Capillary pH<7, both initially and in ROSC pts 2 hours after CPR onset, was similarly associated with high mortality in both groups (p values are in table 3). Additionally, a long duration of CPR more than 45 minutes was as well associated with high mortality in both groups (table 3). In the univariate analysis, a long CPR duration of more than 45 minutes in IHCA pts (OR 25.144 p 0.003) as well as non-shockable initial rhythm in both groups (OR 5.867 p 0.022 in IHCA group and (OR 14.580 p 0.022 in OHCA group), remained as predictors of in-hospital mortality.

In-hospital mortality rates seem to be comparable between IHCA and OHCA pts. A serum lactate level >100mg/dl, both initially and in ROSC pts 2 hours after CPR onset, was associated with poor outcome, especially in IHCA pts. Predictors of mortality in the univariate analysis were long CPR duration more than 45 minutes in IHCA pts as well as non-shockable initial rhythm in both groups.