Predictors and Outcome of in-Hospital Cardiac Arrest Patients in Emergency Department Suez Canal University Hospitals

Mohamed Ragab Elnaggar *

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt.

Ahmed El Sayed Abou Zeid

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt.

Ghada Kamal Elhadary

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt.

Rasha Mahmoud Ahmed

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt.

*Author to whom correspondence should be addressed.


Background: In-hospital cardiac arrest (IHCA) is defined as cessation of cardiac activity, confirmed by the absence of signs of circulation, in a hospitalized patient who had a pulse at the time of admission. The purpose of the present study was to record the definitive predictors of IHCA, focusing on the relation between cause and outcome as well as the influence of location on survival.

Subjects and Methods: This prospective observational study (cross sectional) was carried out in Emergency Department at Suez Canal University Hospital and included 223 patients experiencing IHCA at the Emergency Department (ED).

Results: Our study showed return of spontanous circulation (ROSC) rate of 27.4%, which is lower than those reported in other studies from the region. In our study, we found that the overall mean duration for comprehensive cardiopulmonary resuscitation (CPR) was 21 min (SD ± 10).We found that Pulse, RR, BP, Witnessed and advanced life support (ALS) interventions at time of event were significant positive predictors to ROSC with patients while age, modified early warning score (MEWS), Interval between collapse to start CPR and CPR duration were negative predictors to cognitive impairment with diabetic patients.

Conclusions: IHCA can be predicted using different variable related to patients vital data, laboratories, radiological investigations and patient demographic data which helps in predicting and modifying the outcome in limited situations.

Keywords: Cardiac arrest, mortality prediction, outcome, cardio pulmonary resuscitation

How to Cite

Elnaggar, M. R., Zeid, A. E. S. A., Elhadary, G. K., & Ahmed, R. M. (2022). Predictors and Outcome of in-Hospital Cardiac Arrest Patients in Emergency Department Suez Canal University Hospitals. Cardiology and Angiology: An International Journal, 11(4), 282–294.


Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S. Aetiology of in-hospital cardiac arrest on general wards. Resuscitation. 2016;107:19-24.

Blewer AL, Leary M, Esposito EC, Gonzalez M, Riegel B, Bobrow BJ, et al. Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training: a hospital-based randomized controlled trial*. Crit Care Med. 2012;40(3):787-92.

Nolan JP, et al. Resuscitation-part 1: executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovas-cular care science with treatment recommendations. 2010;81(1):e1-e25.

Timsit JF, Paquin S, Pease S, Macrez A, Aim JL, Texeira A, et al. Evaluation of a continuous training program at Bichat hospital for in-hospital cardiac arrest resuscitation. Ann Fr anesth Reanim. 2006;25(2):135-43.

Abella BS, Alvarado JP, Myklebust H, Edelson DP, Barry A, O’Hearn N, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA. 2005;293(3):305-10.

Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005;111(4):428-34.

Peters R, Boyde M. Improving survival after in-hospital cardiac arrest: the Australian experience. Am J Crit Care. 2007;16(3):240-6; quiz 247.

Chang W-H, Huang C, Chien D, Su Y, Lin P, Tsai C. Factors analysis of cardiopulmonary resuscitation outcomes in the elderly in Taiwan. Int J Gerontol. 2009;3(1):16-25.

Ebell MH, Afonso AM. Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis. Fam Pract. 2011;28(5):505-15.

Limpawattana P, Siriussawakul A, Chandavimol M, Sawanyawisuth K, Chindaprasirt J, Senthong V, et al. National data of CPR procedures performed on hospitalized Thai Older population patients. Int J Gerontol. 2015;9(2):67-70.

Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S, et al. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014;85(8):987-92.

Shao F, Li CS, Liang LR, Qin J, Ding N, Fu Y, et al. Incidence and outcome of adult in-hospital cardiac arrest in Beijing, China. Resuscitation. 2016;102:51-6.

Ballew KA, Philbrick JT. Causes of variation in reported in-hospital CPR survival: a critical review. Resuscitation. 1995;30(3):203-15.

Buff DD, Fleisher JM, Roca JA, Jaffri M, Wyrwinski PM. Circadian distribution of in-hospital cardiopulmonary arrests on the general medical ward. Arch Intern Med. 1992;152(6):1282-8.

Marcu CB, Juhasz D, Donohue TJ. Circadian variation and outcome of in-hospital cardiopulmonary resuscitation. Conn Med. 2005;69(7):389-93.

Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council guidelines for resuscitation 2015: section 3. Adult advanced life support. Resuscitation. 2015;95:100-47.

Nolan J, Soar J, Eikeland H. The chain of survival. Resuscitation. 2006;71(3):270-1.

Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73(1):29-39.

Herlitz J, Bång A, Aune S, Ekström L, Lundström G, Holmberg S. Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas. Resuscitation. 2001;48(2):125-35.

Eftestøl T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105(19):2270-3.

Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367(20):1912-20.

Spearpoint KG, McLean CP, Zideman DA. Early defibrillation and the chain of survival in’in-hospital’adult cardiac arrest; minutes count. Resuscitation. 2000;44(3):165-9.

Sunde K. SOPs and the right hospitals to improve outcome after cardiac arrest. Best Pract Res Clin Anaesthesiol. 2013;27(3):373-81.

Elfaituri MK, et al. Incidence of Infection-related mortality in cancer patients: trend and survival analysis. American Society of Clinical Oncology; 2019.

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632-4.

Argilés JM, Busquets S, Stemmler B, López-Soriano FJ. Cancer cachexia: understanding the molecular basis. Nat Rev Cancer. 2014;14(11):754-62.

Petrocca F, Visone R, Onelli MR, Shah MH, Nicoloso MS, de Martino I, et al. E2F1-regulated microRNAs impair TGFβ-dependent cell-cycle arrest and apoptosis in gastric cancer. Cancer Cell. 2008;13(3):272-86.

Wang EY, Dixson J, Schiller NB, Whooley MA. Causes and predictors of death in patients with coronary heart disease (from the heart and soul study). Am J Cardiol. 2017;119(1):27-34.

Swor RA, Jackson RE, Cynar M, Sadler E, Basse E, Boji B, et al. Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Ann Emerg Med. 1995;25(6):780-4.

Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation. 2000;47(2):125-35.

Leung K, Lui C, Cheung K, Tsui K, Tang Y. Outcome and prognostic factors of patients in out-of-hospital cardiac arrests presenting with non-shockable rhythm in Hong Kong. HK J Emerg Med. 2012;19(1):6-12.

Rajaram R, Rajagopalan RE, Pai M, Mahendran S. Survival after cardiopulmonary resuscitation in an urban Indian hospital. Natl Med J India. 1999;12(2):51-5.

Moosajee US, et al. Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country. Int J Emerg Med. 2018;11(1):1-9.

Eckstein M, Stratton SJ, Chan LS. Cardiac arrest resuscitation evaluation in los Angeles: CARE-LA. Ann Emerg Med. 2005;45(5):504-9.

Nishiuchi T, Hayashino Y, Fukuhara S, Iwami T, Hayashi Y, Hiraide A, et al. Survival rate and factors associated with 1-month survival of witnessed out-of-hospital cardiac arrest of cardiac origin with ventricular fibrillation and pulseless ventricular tachycardia: the Utstein Osaka project. Resuscitation. 2008;78(3):307-13.

Ødegaard S, Olasveengen T, Steen PA, Kramer-Johansen J. The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2009;80(8):843-8.

Spaite DW, Bobrow BJ, Vadeboncoeur TF, Chikani V, Clark L, Mullins T, et al. The impact of prehospital transport interval on survival in out-of-hospital cardiac arrest: implications for regionalization of post-resuscitation care. Resuscitation. 2008; 79(1):61-6.

Vukmir RB. Survival from prehospital cardiac arrest is critically dependent upon response time. Resuscitation. 2006;69(2):229-34.

Yanagawa Y, Sakamoto T. Analysis of prehospital care for cardiac arrest in an urban setting in Japan. J Emerg Med. 2010;38(3):340-5.

Naqvi S, Siddiqi R, Hussain SA, Batool H, Arshad H. School children training for basic life support. J Coll Physicians Surg Pak. 2011;21(10):611-5.

Hoang BH, Dao XD, Nakahara S, Sakamoto T. The need for improving access to emergency care through community involvement in low‐ and middle‐income countries: A case study of cardiac arrest in Hanoi, Vietnam. Emerg Med Australas. 2018;30(6):867-9.

Vattanavanit V, Bhurayanontachai R. Clinical outcomes of 3-year experience of targeted temperature management in patients with out-of-hospital cardiac arrest at Songklanagarind Hospital in Southern Thailand: an analysis of the MICU-TTM registry. Open access emergency medicine: OAEM. 2016;8:67.

Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med. 2014;20(3):233-41.

Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5).

Yucel N, Ozturk Demir T, Derya S, Oguzturk H, Bicakcioglu M, Yetkin F. Potential risk factors for in-hospital mortality in patients with moderate-to-severe blunt multiple trauma who survive initial resuscitation. Emerg Med Int. 2018;2018:6461072.

Demetriades D, Murray J, Charalambides K, Alo K, Velmahos G, Rhee P, et al. Trauma fatalities: time and location of hospital deaths. J Am Coll Surg. 2004;198(1):20-6.

MacLeod JB, Lynn M, McKenney MG, Jeroukhimov I, Cohn SM. Predictors of mortality in trauma patients. Am Surg. 2004;70(9):805-10.

MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. The national study on costs and outcomes of trauma. J Trauma Acute Care Surg. 2007;63(6):S54-67.

Paffrath T, Lefering R, Flohé S, TraumaRegister DGU. How to define severely injured patients?—an Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45;Suppl 3:S64-9.

Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj Epidemiol. 2016;3(1):1.

Davis JW, Parks SN, Kaups KL, Gladen HE, O’Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41(5):769-74.

de Vos R, de Haes HC, Koster RW, de Haan RJ. Quality of survival after cardiopulmonary resuscitation. Arch Intern Med. 1999;159(3):249-54.

FitzGerald JD, Wenger NS, Califf RM, Phillips RS, Desbiens NA, Liu H, et al. Functional status among survivors of in-hospital cardiopulmonary resuscitation. SUPPORT Investigators Study to Understand Progress and Preferences for Outcomes and Risks of Treatment. Arch Intern Med. 1997;157(1):72-6.

Harrison DA, Patel K, Nixon E, Soar J, Smith GB, Gwinnutt C, et al. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation. 2014;85(8):993-1000.

Cocchi MN, Miller J, Hunziker S, Carney E, Salciccioli J, Farris S, et al. The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest. Minerva Anestesiol. 2011;77(11):1063-71.

Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation. 2013;128(23):2488-94.

Fabbri A, Marchesini G, Spada M, Iervese T, Dente M, Galvani M, et al. Monitoring intervention programmes for out-of-hospital cardiac arrest in a mixed urban and rural setting. Resuscitation. 2006;71(2): 180-7.

Chakravarthy M, Mitra S, Nonis L. Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital. Indian Heart J. 2012;64(1):7-11.

Andrew E, Nehme Z, Bernard S, Smith K. The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest. Resuscitation. 2017;110:42-7.