Journal Article

Temporal trends in the causes of in-hospital cardiac arrest: a retrospective observational cohort study on the limitations of the current alert system at a tertiary hospital in Korea

Kim, Min-Seok, Kim, Jun, Hong, Sang-Bum, Kim, Ah-Ram, Shin, Yujung, Cha, Myung-Jin, Oh, Hae Yeon, Go, Un Jung, Cho, Min Soo, Choi, Kee-Joon, Nam, Gi-Byoung, Lee, Joong Min, Lee, JinMi

2025

Overview

ObjectivesIn-hospital cardiac arrest (IHCA) is associated with high mortality and serious neurological sequelae. Although medical alert systems have evolved, the ability of these systems to influence changes in IHCA incidence and aetiology remains limited.DesignsRetrospective observational cohort study.SettingsA single tertiary hospital in South Korea, covering tertiary care levels.ParticipantsA total of 1994 adult patients (≥18 years) who experienced 2121 episodes of IHCA between January 2011 and December 2019. Patients with out-of-hospital cardiac arrest, those aged ≤18 years and those with do-not-resuscitate orders were excluded. The mean age of patients was 63.0 years (SD, 14.6); 64.1% were male.InterventionsNot applicable.Main outcome measuresThe incidence and temporal trends of IHCA were stratified by aetiology (cardiac vs non-cardiac). Additional analyses examined changes in arrhythmic versus non-arrhythmic causes over time using Poisson regression.ResultsCardiac arrhythmia was the most common cause of IHCA (314 of 2121, 14.8%; incidence: 0.42/1000 admissions), including ventricular tachycardia (n=86), ventricular fibrillation (n=87) and Torsades de Pointes (n=79). Respiratory failure was the second most common cause (266 of 2121, 12.5%; incidence: 0.36/1000 admissions). The incidence of IHCA due to respiratory failure in 2011 was 0.63/1000 admissions, which decreased to 0.20/1000 admissions by 2019 (β=0.883, 95% CI 0.842 to 0.926, p for trend 0.007; Poisson p<0.001). In contrast, the incidence of IHCA due to arrhythmia in 2011 was 0.49/1000 admissions and remained similar over time (0.29/1000 admissions in 2019, β=0.972, 95% CI 0.932 to 1.015, p for trend 0.194; Poisson p=0.198).ConclusionIHCA causes have shown significant temporal shifts. Arrhythmia has become the leading cause of IHCA, with incidences remaining stable, whereas a marked decrease has been observed in respiratory-related IHCA. Therefore, enhanced in-hospital cardiac monitoring systems are required for early detection.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acute coronary syndromes / Aged / Airway management / Arrhythmias, Cardiac - complications / Arrhythmias, Cardiac - epidemiology / Cardiac arrest / Cardiac arrhythmia / CARDIOLOGY / Cardiopulmonary resuscitation / Cardiovascular medicine / CPR / Data collection / Death, Sudden, Cardiac / Diabetes / Emergency medical care / Etiology / Female / Heart Arrest - epidemiology / Heart Arrest - etiology / Heart failure / Hospitals / Humans / Hypertension / Incidence / INTENSIVE & CRITICAL CARE / Ischemia / Male / Medical records / Middle Aged / Mortality / Patients / Republic of Korea - epidemiology / Retrospective Studies / Right to die / Sepsis / Tertiary Care Centers / Trends