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Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion

Jack Chen, Lixin Ou, Kenneth M Hillman, Arthas Flabouris, Rinaldo Bellomo, Stephanie J Hollis and Hassan Assareh
Med J Aust 2014; 201 (3): 167-170. || doi: 10.5694/mja14.00019

Summary

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs).

Design, setting and participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009.

Main outcome measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge.

Results: RRS uptake increased from 32% in 2002 to 74% in 2009. This increase was associated with a 52% decrease in IHCA rate, a 55% decrease in IHCA-related mortality rate, a 23% decrease in hospital mortality rate and a 15% increase in survival to discharge after an IHCA (all P < 0.01). The adjusted absolute reductions in IHCA-related mortality and hospital mortality were 1.49 (95% CI, 1.30–1.68) and 4.05 (95% CI, 3.17–4.76) patients per 1000 admissions, respectively. The decrease in IHCA incidence rate accounted for 95% of the reduction in IHCA-related mortality. In contrast, the increase in IHCA survival accounted for only 5% of the reduction in IHCA-related mortality.

Conclusions: During nearly a decade, as RRSs were progressively introduced, there was a coincidental reduction in IHCA, IHCA-related deaths and hospital mortality and an increased survival to hospital discharge after an IHCA. Reduced IHCA incidence, rather than improved postcardiac arrest survival, was the main contributor to the reduction in IHCA mortality.

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  • Jack Chen1
  • Lixin Ou1
  • Kenneth M Hillman1
  • Arthas Flabouris2,3
  • Rinaldo Bellomo4
  • Stephanie J Hollis1
  • Hassan Assareh1

  • 1 University of New South Wales, Sydney, NSW.
  • 2 Intensive Care, Royal Adelaide Hospital, Adelaide, SA.
  • 3 School of Medicine, University of Adelaide, Adelaide, SA.
  • 4 Austin Hospital, Melbourne, VIC.

Correspondence: jackchen@unsw.edu.au

Acknowledgements: 

Our study was supported by National Health and Medical Research Council project grants APP1009916 and APP1020660.

Competing interests:

No relevant disclosures.

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