• Anthony P Carnicelli, Ryan Keane, Kelly M Brown, Daniel B Loriaux, Payton Kendsersky, Carlos L Alviar, Kelly Arps, David D Berg, Erin A Bohula, James A Burke, Jeffrey A Dixson, Daniel A Gerber, Michael Goldfarb, Christopher B Granger, Jianping Guo, Robert W Harrison, Michael Kontos, Patrick R Lawler, P Elliott Miller, Jose Nativi-Nicolau, L Kristin Newby, Lekha Racharla, Robert O Roswell, Kevin S Shah, Shashank S Sinha, Michael A Solomon, Jeffrey Teuteberg, Graham Wong, Sean van Diepen, Jason N Katz, and David A Morrow.
• Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: carnicel@musc.edu.
• Resuscitation. 2023 Feb 1; 183: 109664109664.

BackgroundCardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA.MethodsThe Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA.ResultsWe analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p < 0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p < 0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p < 0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p < 0.001) and in-hospital mortality (36.1% vs 44.1%, p < 0.001).ConclusionDespite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.Copyright © 2022 Elsevier B.V. All rights reserved.

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