Alex KlacmanLiteratureSummary Table: Significance of Adult In-Hospital Cardiac Arrest in the United StatesType of Table:Significance
Summarize Research articles using this table format:
Source / Study Purpose / Theoretical Framework / Research Design & Procedures / Sample Size & Description / Variables &Measurement Instrument(s) / Key Results / Comments/
Critique
Merchant et al. (2011) / Estimate the incidence of adult in-hospital cardiac arrest (IHCA) in the United States from January 1, 2003 to December 31, 2007 / None / Prospective data analysis from hospitals reporting into the national Get with the Guidelines-Resuscitation (GWTG-R) database and American Hospital Association database to estimate incidence of adult in-hospital cardiac arrest during study period.
Research design? / All hospitals within the U.S. utilized to calculate annual hospital bed days (n=5445).
Only 433 hospitals within the U.S. utilized to determine number of adult cardiac arrests during study period.
Sample description? / Variables:
Mean number of adult in-hospital cardiac arrests during study period
Measurement Instruments:
GWTG-R database which is a quality improvement tool for hospitals to report resuscitation data
American Hospital Association annual hospital survey describing characteristics of all hospitals within the U.S. / Incidence of adult IHCA between 2003 and 2007 was 209,000
Incidence rate of IHCA may be increasing / Generalizability limited due to only 433 hospitals participating in GWTG-R utilized
Quality of data entered could have affected study results
Girotra et al. (2012) / Describe trends in adult IHCA survival to discharge, acute resuscitation survival, post-resuscitation survival, and neurologic outcome in survivors from 2000 to 2009 / None / Prospective data analysis from hospitals reporting into the national Get with the Guidelines Resuscitation (GWTG-R) database.
Research design? / 86,625 patients from 374 hospitals utilized to calculate post-cardiac arrest outcomes.
Sample description? / Variables
Rate of survival to hospital discharge during study period
Rate of acute resuscitation survival (return of spontaneous circulation [ROSC] at least 20 minutes)
Neurologic disability in survivors
Measurement Instruments:
GWTG-R database which is a quality improvement tool for hospitals to report resuscitation data
Cerebral Performance Category (CPC) Score to measure neurologic disability / Rate of survival to hospital discharge is 17.0% during study period
Acute resuscitation survival increased during study period from 42.7% in 2000 to 54.1% in 2009
Decrease in clinically significant neurologic disability during study period / Study also showed that while rates of survival increased, patients during the study period were sicker at time of arrest.
Generalizability limited due to only 374 hospitals participating in GWTG-R utilized for study
Quality of data entered could have affected study results
Girotra et al. (2014) / Describe variation of trends in IHCA across hospitals in the U.S from 2000 to 2010 / None / Prospective data analysis from hospitals reporting into the national Get with the Guidelines Resuscitation (GWTG-R) database
Research design? / 93,342 patients from 231 hospitals utilized for trends in variation of IHCA across hospitals in the U.S.
Sample description? / Variables:
Primary independent variable: calendar year; primary dependent variable: hospital rate of survival to discharge;
Secondary independent variables:
Geographic location of hospital; ownership of hospital; teaching status; bed number; patient demographics at time of arrest; secondary dependent variable: hospital rate of survival to discharge
Measurement Instruments:
GWTG-R database which is a quality improvement tool for hospitals to report resuscitation data / Table 1 gives overall mean of many variables over the study period
During study period rates of shockable cardiac arrest decreased, however, patients at time of arrest were sicker
Mean unadjusted survival rate from IHCA was 18.2%
Rate of survival at academic medical centers is significant; no other hospital characteristics significant / Generalizability limited due to only 231 hospitals participating in GWTG-R utilized for study
Quality of data entered could have affected study results
Study hospital characteristics not similar so could have affected results
Kolte et al. (2015) / Determine if regional variations in incidence, survival to discharge, and resource use exist in the U.S. during study period
Determine whether patient and/or hospital characteristics can explain regional variation / None / Prospective data analysis from the Nationwide Inpatient Sample (NIS) for study period (2003-2011).
Research design? / 838,465 patients from approximately 1000 hospitals with ICD 9 codes for cardiopulmonary resuscitation
Sample description? / Variables
Incidence of IHCA across four regions and across individual states
Survival to hospital discharge following IHCA across four regions and across individual states
Discharge disposition following IHCA
Total hospital costs following IHCA
Measurement Instruments:
NIS- largest database of in-patient hospitals in the U.S. / Significant regional variations exist in rates of, survival from, and total hospital cost for IHCA
Lowest rate of IHCA in Midwest; highest rate of IHCA in West
Survival to hospital discharge highest in Midwest and lowest in South
Highest rates of discharge home in West; lowest rates of discharge home in Northeast
Highest cost for IHCA in West / Generalizability limited due to number of hospitals participating in NIS database
Quality of data entered could have affected study results
Use of ICD 9 code for CPR only could have affected study results
Sabedra et al. (2015) / Determine whether use of Computerized Assessment for Mild Cognitive Injury (CAMCI) is feasible in post-cardiac arrest patients to determine cognitive deficits / None / Prospective convenience sample from patients at one hospital from April 2010 through July 2013 who suffered cardiac arrest
Research design / 219 patients who awoke following cardiac arrest
Sample description? / Variables
Neurologic outcome following arrest and at hospital discharge
Measurement Instruments
CPC score
Modified Rankin Score (MRS)
CAMCI / Use of CAMCI is feasible in post-cardiac arrest patients / Cognitive deficits present in the immediate period after post-cardiac arrest
Majority of study subjects had memory, attention, and executive function
Small sample size which could have affected study results
Study occurred at one hospital so results are not generalizable
Piegza et al. (2015) / Determine incidence of depression and anxiety in cardiac arrest patients between one and six months post-arrest / None / Questionnaire of pat
What is the research design?
What did the researchers do/ / Study population: 30 patients between one month and six months post cardiac arrest
Reference population: 31 patients suffering acute myocardial infarct between one month and six months post cardiac arrest
Control population: 30 healthy individuals with characteristics similar to study population
Where?
Description of sample? / Variables:
Depression in study, reference, and control population
Anxiety in study, reference, and control population
Prevalence of depression in study, reference, and control population
Prevalence of anxiety in study, reference, and control population
Measurement Instruments
Questionnaire developed by researchers
Hamilton Depression Rating Scale
Hamilton Anxiety Rating Scale / Depression rate higher in study population vs. reference population but not significant
Anxiety rate higher in study population vs. reference population and is statistically significant
Sixty percent of study population developed depression / Small sample size
No description of reliability and validity of researcher developed questionnaire given
Study completed at one hospital in Poland
Raina, Rittenberger, Holm, & Callaway (2015) / Determine functional outcomes at one month, six months, and one year post-cardiac arrest / None / Longitudinal observational study
What did the researchers do? / 49 patients initially recruited; 29 participants remained in study at one-year due to attrition
Where?
Description of sample? / Variables:
Global disability
Quality of life
Symptoms of depression
Cognitive impairment
Activity limitations
Participation restrictions
Measurement Instruments:
For global disability
- Cerebral Performance Category
- Modified Rankin Scale
- Glasgow Outcome Scale Extended (GOSE)
For symptoms of depression- Geriatric Depression Scale
For cognitive impairment
- Adult Lifestyle and Function Interview-Mini Mental Status Examination (ALFI-MMSE)
- Telephone Interview of Cognitive Status (TICS)
For participation restrictions—Reintegration to Normal Living Index (RNLI) / For global disability participants had good outcomes at all time points in the study
For GOSE participants at all points had lower moderate disability and for HUI-3 participants had severe disability
No cognitive impairment noted using ALFI-MMSE and TICS
Depressive symptoms at all study points
Study participants had problems performing activities of daily living, requiring assistance
Study participants did not feel reintegrated into society / Some scores increased at 6-mos and 12-mos showing that recovery continues for months post-cardiac arrest
Small study population
Most patients in study suffered from ventricular fibrillation, known to cause shorter arrest time, so study results may overestimate what occurs in asystole and pulseless electrical activity
Assume that study population came from two hospitals based on Institutional Review Board Approval but the researchers do not describe where study population came from
Andersson, Rosén, & Sunnerhagen (2015) / Describe characteristics of those who are alive/dead following cardiac arrest between 1995 and 1999 / None / Longitudinal observational study
What did the researchers do? / 14 patients out of original cohort of 104 patients; 8 patients participated in study; 6 declined to participate / Variables
Cognitive ability
Co-morbidities
Quality of life
Dependence in performing activities of daily living
Presence of post-traumatic stress disorder
Presence of anxiety or depression
Measurement Instruments:
Cognitive ability- Mini Mental Status Exam (MMSE); Montreal Cognitive Assessment (MoCA)
Co-morbidities- self-reported co-morbidity questionnaire (SCQ)
Quality of life—EuroQol-5 dimensions (EQ-5D)
Dependence in ADL’s—Barthel Index
Presence of post-traumatic stress disorder—PTSD CheckList Civilian version (PCL-C)
Anxiety and depression- Hospital anxiety and depression scale (HADS) / Fifty percent of participants had impaired cognition using MMSE
Eighty-eight percent of patients had impaired cognition using MoCA scale
Only 25% of study participants (2/8) reported no co-morbid conditions
Thirty-seven percent of study participants had low quality of life on (EQ-5D)
PTSD, anxiety, depression rare / Small study size limits generalizability of results
Study population came from one hospital
Characteristics of long-term cardiac arrest survivors may have changed in past 17 years
Chan et al. (2014) / Describe readmission rates and costs in survivors of in-hospital arrest from January 2000 to January 2008 / None / Prospective data analysis from hospitals reporting into the national Get with the Guidelines Resuscitation (GWTG-R) database.
Research design? / 6972 patients from 401 hospitals
Sample description? / Variables:
Readmission rate
Inpatient resource use
Measurement Tool
GWTG-R database which is a quality improvement tool for hospitals to report resuscitation data / 30-day mean readmission incidence rate of 35 readmissions per 100 patients
One year mean readmission incidence rate of 185 readmissions per 100 patients
Mean cost for readmission at 30-days for entire cohort was $7741 and $18,620 at one year / Generalizability limited due to only 401 hospitals participating in GWTG-R utilized
Only Medicare beneficiaries utilized in the study which severely limits generalizability of results
Medicare reimburses at lower rates than private insurance
: Summarize non-research sources using this table format
Source / Type of Source / Key Information / Comments/CritiqueAmerican Hospital Association (2014) / Website / The American Hospital Association described the response rate on the annual hospital survey as greater than 75% per year.
When data is missing, estimates from past data and comparisons with similar hospitals utilized and quality checks in place to improve validity / 75% response rate is good, however, estimation of data may limit the results of the survey. Unable to view survey to determine if missing data is noted in results.
Binks and Nolan (2010) / Journal Article[Dr J1] / Description of post-cardiac arrest syndrome consisting of brain injury, myocardial dysfunction, and ischemic-reperfusion cascade, in addition to the underlying clinical problem causing arrest. / Describes phases of post-cardiac arrest syndrome focusing on the immediate and early post-arrest phases.
Jentzer, Chonde, and Dezfulian (2015) / Journal Article[Dr J2] / Details myocardial dysfunction following cardiac arrest and characterizes it as a shock state. Up to two-thirds of patients experience post-cardiac arrest myocardial dysfunction / Excellent description of pathophysiology of post-arrest myocardial dysfunction. Describes treatment of myocardial dysfunction.
[Dr J1]This is a literature review
[Dr J2]This is a literature review