Location of In-Hospital Cardiac Arrest: An Updated Analysis of Epidemiology, Emergency Response, and Outcomes

OBJECTIVES: In the United States, in-hospital cardiac arrest (IHCA) affects about 290,000 adults per year. This study provides an updated and expanded analysis of the epidemiology, resuscitative response, and outcomes following IHCA in various hospital locations. DESIGN: This observational cohort study used the prospectively collected nationwide Get With The Guidelines-Resuscitation (GWTG-R) registry. SETTING: GWTG-R registry. PATIENTS: All adult patients with an index cardiac arrest in the emergency department (ED), ICU, or ward (telemetry or nontelemetry) between 2010 and 2021 were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 235,560 IHCA events were included, of which 53.4% ( n = 125,798) occurred in the ICU, 14.0% ( n = 32,862) in the ED, 16.0% ( n = 37,780) on telemetry wards, and 16.6% ( n = 39,120) on nontelemetry wards. Shockable initial rhythms were identified in 15.9% ( n = 37,465) of IHCAs, with the highest prevalence in monitored locations. Adjusted for confounding factors, a survival rate of 21.2% (95% CI, 20.6-21.9%) was found in the ICU, 22.2% (95% CI, 21.4-23.1%) in the ED, 23.0% (95% CI, 22.3-23.7%) on telemetry wards, and 19.2% (95% CI, 18.4-20.0%) on nontelemetry wards. CONCLUSIONS: Survival after IHCA is low and varies based on the hospital location of the IHCA. Patients with IHCA on nontelemetry wards have the lowest probability of in-hospital survival after IHCA.