From the Guidelines
In-hospital cardiac arrests have significantly better outcomes compared to out-of-hospital cardiac arrests, with a survival rate of 22.3% to 25.5% versus 10.8%, respectively. This disparity is largely due to the immediate recognition and response to cardiac arrest in the hospital setting, where trained healthcare providers and advanced equipment are readily available 1. Key factors contributing to the improved outcomes in in-hospital cardiac arrests include:
- Immediate recognition of cardiac arrest and activation of the emergency response system
- Early initiation of high-quality CPR
- Rapid defibrillation with an automated external defibrillator (AED) when necessary
- Access to medications and other advanced life support measures
In contrast, out-of-hospital cardiac arrests often face delays in recognition and response, with variable bystander CPR quality and delayed EMS response times 1. These delays can significantly impact survival rates, making in-hospital cardiac arrests more likely to result in successful resuscitation and discharge. The underlying causes of cardiac arrest also differ between in-hospital and out-of-hospital settings, with in-hospital arrests more commonly resulting from respiratory failure, sepsis, or complications of critical illness, and out-of-hospital arrests predominantly being cardiac in origin 1.
From the Research
In-Hospital vs Out-of-Hospital Cardiac Arrest
- The management of cardiac arrest, whether in-hospital or out-of-hospital, involves several key components including medications, cardiopulmonary resuscitation (CPR), and identification of reversible causes 2, 3, 4, 5, 6.
- Medications such as epinephrine are commonly used in cardiac arrest management, with evidence suggesting that epinephrine can improve rates of return of spontaneous circulation (ROSC) but may not be associated with improved survival or neurologic outcomes 2, 3, 5.
- The route of administration for medications like epinephrine can include intravenous (IV) or intraosseous (IO), with IV being the preferred route 2.
- For patients requiring interfacility transport after cardiac arrest, maintaining postresuscitation care during transport is crucial, including attention to airway, vascular access, and cardiopulmonary monitoring 4.
- The management of cardiac arrest in the emergency department involves good quality CPR, focused investigations to identify reversible causes, and cause-specific treatments, with team members having clearly defined roles and access to required equipment 6.
- Specific considerations are needed for cardiac arrest due to major trauma, accidental hypothermia, or in the setting of advanced pregnancy, highlighting the complexity of cardiac arrest management 6.