Challenges in resuscitation and survival factors of in-hospital cardiac arrest with suspected cardiovascular etiology: A multicenter retrospective study in Beijing, China

Background and Aim

Cardiovascular disease affects both the elderly and younger populations, with cardiogenic arrest being the leading cause of in-hospital cardiac arrest (IHCA). The prognosis of IHCA related to cardiovascular diseases remains uncertain. This study aims to explore the characteristics, outcomes, and survival factors of IHCA with suspected cardiovascular etiology.

Methods and Results

This retrospective study investigated IHCA suspected to be of cardiovascular origin among adult patients across multiple hospitals in Beijing, China, from January 2022 to December 2023. A total of 791 arrests were recorded, with a median age of 70 years (IQR 61–79), and 65.1 % were male. Ventricular fibrillation/pulseless ventricular tachycardia was the initial rhythm in 46.8 % of cases. Of the 791 patients, 394 (49.8 %) achieved return of spontaneous circulation (ROSC), and 302 (38.2 %) had more than one arrest during hospitalization. Ultimately, 130 patients (16.4 %) survived to hospital discharge. Multivariable Cox regression showed that ROSC without mechanical circulatory support (HR: 2.68; 95 % CI 1.58–4.56), shockable initial rhythm (HR: 1.52; 95 % CI 1.06–2.17), and a duration of cardiopulmonary resuscitation (CPR) of ≤ 30 min (HR: 1.82; 95 % CI 1.13–2.93) were independently associated with a higher likelihood of survival to discharge. In contrast, multiple CPR episodes (HR: 0.53; 95 % CI 0.36–0.76), prolonged hospital stays (HR: 0.90; 95 % CI 0.88–0.93), and IHCA in urban centers (HR: 0.60; 95 % CI 0.42–0.87) were linked to poorer survival.

Conclusions

Among patients with suspected cardiovascular-related IHCA, both the proportion of shockable initial rhythms and ROSC rates were high; however, survival to discharge remained low.