Predictive factors of spontaneous circulation return following in-hospital cardiac arrest: a cross-sectional study

Saeed  Safari; Ali  Safdarian; Mahmoud  Yousefifard; Seyed Hadi  Aghili; Mehri Farhang  Ranjbar

doi:10.18502/fem.v9i1.18066

Saeed Safari Research Center for Trauma in Police Operations, Directorate of Health, Rescue&Treatment, Police Headquarter, Tehran, Iran.
Ali Safdarian Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Seyed Hadi Aghili Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mehri Farhang Ranjbar Research Center for Trauma in Police Operations, Directorate of Health, Rescue&Treatment, Police Headquarter, Tehran, Iran.

DOI: https://doi.org/10.18502/fem.v9i1.18066

Keywords: Advanced Cardiac Life Support; Cardio-Pulmonary Resuscitation; Spontaneous Circulation Return

Abstract

Objective: Existing predictive models for in-hospital cardiac arrest (IHCA) outcomes are mainly based on out-of-hospital cardiac arrest (OHCA) studies. This study aimed to identify factors that can independently predict the sustained return of spontaneous circulation (ROSC) following IHCA.

Methods: This retrospective cross-sectional study included all patients aged 18 or older who underwent cardiopulmonary resuscitation (CPR) following IHCA in the emergency departments of two general hospitals in Tehran, Iran, from March 2021 to April 2024. The association of patient baseline characteristics, type of cardiac arrest, CPR characteristics, time-related parameters, and laboratory data with sustained ROSC were evaluated using multivariate logistic regression analysis trying to identify independent associated factors of sustained ROSC following IHCA.

Results: 614 patients with a mean age of 68.23±17.65 (range: 18-115) years meeting the eligibility criteria were included (59.28% Male). 184 (29.96%) cases experienced sustained ROSC. Multivariate logistic regression analysis revealed a significant association between sustained ROSC and CPR duration less than 30 minutes (coefficient=4.38, 95% CI: 3.70,5.06, P<0.001), arrest due to cardiac etiologies (coefficient=1.05, 95% CI: 0.35,1.74, P=0.003), and administration of IV bicarbonate (coefficient=1.42, 95% CI: 0.72,2.13, P<0.001). Administration of amiodarone showed a borderline association with sustained ROSC (coefficient=1.07, 95% CI: -0.03,2.18, P=0.05).

Conclusion: CPR duration of less than 30 minutes, arrest with cardiac etiologies, administration of bicarbonate and amiodarone were independent predictors of sustained ROSC.