In-hospital cardiac arrest: Incidence, prognosis and possible measures to improve survival

Claudio Sandroni, Jerry Nolan, Fabio Cavallaro, Massimo Antonelli

Research output: Contribution to journalArticle

393 Citations (Scopus)


Design: Review. Objective: Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible interventions to improve survival. Results and conclusions: The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hospital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild therapeutic hypothermia is effective as post-arrest treatment of out-of-hospital cardiac arrest due to VF/VT, but its benefit after IHCA and after cardiac arrest with non-VF/VT rhythms has not been clearly demonstrated. © 2006 Springer-Verlag.
Original languageEnglish
Pages (from-to)237-245
Number of pages9
JournalIntensive Care Medicine
Publication statusPublished - 2007


  • Advanced cardiac life support
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiac arrest
  • Cardiopulmonary Resuscitation
  • Cardiopulmonary resuscitation
  • Comorbidity
  • Electric Countershock
  • Female
  • Heart Arrest
  • Heart arrest
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Sudden cardiac death


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