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Survival Rate from In-Hospital Cardiac Arrest Is Lower During Off Hours
But not in the emergency department or on the trauma service
Small single-hospital studies show lower rates of survival from in-hospital cardiac arrest at night than during the day. In the current study, researchers analyzed data from the 507 hospitals in the National Registry of Cardiopulmonary Resuscitation to compare outcomes of in-hospital cardiac arrest between 07:00 and 22:59 (day/evening) and between 23:00 and 06:59 (night).
From 2000 to 2007, about 59,000 arrests occurred at night and 28,000 occurred during the day/evening. Rates of survival to discharge were significantly lower at night than during the day/evening (15% vs. 20%), as were rates of return of spontaneous circulation for >20 minutes (45% vs. 51%), survival at 24 hours (29% vs. 35%), and favorable neurologic outcome based on cerebral performance category scoring (11% vs. 15%). Among day/evening cases, survival rates were significantly higher on weekdays than on weekends (21% vs. 17%; odds ratio, 1.15), but, among night cases, survival rates were similar on weekdays and weekends (about 15%; OR, 1.02). The first documented rhythm was significantly more likely to be asystole at night than during day/evening hours (40% vs. 34%) and less likely to be ventricular fibrillation (20% vs. 23%).
Comment: The results of this multivariate regression analysis that was adjusted for patient, event, and hospital characteristics are no surprise. Factors during nights and weekends that might explain the worse outcomes include diminished physician psychomotor skills, lighter staffing, less physician familiarity with cross-covered patients, and fewer visitor "witnesses." Of note, survival rates did not vary by time of day or day of the week only in the emergency department and on the trauma service, which typically are staffed with attending physicians and senior residents 24/7.
— John A. Marx, MD, FAAEM, FACEP
Published in Journal Watch Emergency Medicine March 14, 2008
Citation(s):
Peberdy MA et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008 Feb 20; 299:785.
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