Special report

Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’: A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa☆,☆☆

Previous studies have reported positive associations between out-of-hospital cardiac arrest (OHCA) and air pollutant concentrations, but there are inconsistencies across studies. We aimed to investigate the association between pollutant concentrations and the risk of OHCA in Singapore.

We did a time series analysis of all cases of OHCA in Singapore reported between July 1, 2010, and Dec 31, 2018, to the Pan-Asian Resuscitation Outcomes Study (PAROS), a prospective, population-based registry. Using multivariable fractional polynomial modelling, we investigated the immediate (day 0) and lagged (up to 5 days after exposure) association between 10 μg/m³ increases in concentrations of particulate matter with a diameter of 2·5 μm or smaller (PM_2·5), particulate matter with a diameter of 10 μm or smaller (PM₁₀), ozone (O₃), nitrogen dioxide (NO₂), and sulphur dioxide (SO₂) and 1 mg/m³ increase in carbon monoxide (CO) and relative risk (RR) of OHCA.

We extracted data for 18 131 cases of OHCA. The median age of this cohort of cases was 65 years (IQR 56–80), 6484 (35·8%) were female, 11 647 (64·2%) were male, 12 270 (67·7%) were Chinese, 2873 (15·8%) were Malay, and 2010 (11·1%) were Indian. Every 10 μg/m³ increase in PM_2·5 was associated with increased risk of OHCA (RR 1·022 [95% 1·002–1·043]) over the next 2 days, which decreased over the subsequent 3 days (3–5 days after exposure; 0·976 [0·955–0·998]). For PM₁₀, O₃, NO₂, and SO₂, we did not observe any associations between increased concentration and risk of OHCA on day 0 or cumulative risk over time (ie, at 0–1 days, 0–2 days, 0–3 days, 0–4 days, 0–5 days, and 3–5 days after exposure). For CO, we observed a cumulative decreased risk of OHCA across 0–5 days after exposure (0·876 [0·770–0·997]) and at days 3–5 after exposure (0·810 [0·690–0·949]). We observed effect modification of the association between increasing PM_2·5 concentration and OHCA 0–2 days after exposure by cardiac arrest rhythm (non-shockable 1·027 [1·004–1·050] vs shockable 1·002 [0·956–1·051]) and location of OHCA (at home: 1·033 [1·008–1·057] vs not at home 0·955 [0·957–1·035]). In hypothetical modelling, the number of OHCA events associated with PM_2·5 could be reduced by 8% with a 1 μg/m³ decrease in PM_2·5 concentrations and by 30% with a 3 μg/m³ decrease in PM_2·5 concentrations.

Increases in PM_2·5 concentration were associated with an initial increased risk of OHCA and a subsequent reduced risk from 3–5 days after exposure, suggesting a short-term harvesting effect. A decrease in PM_2·5 concentrations could reduce population demand for emergency health services.

National Medical Research Council, Singapore, under the Clinician Scientist Award, Singapore and the Singapore Translational Research Investigator Award (MOH-000982-01).

American Heart Association quality metrics of resuscitation include time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of airway device placement in trachea. This study examined trends in adherence to these quality metrics in the ICU and identified predictors of failure to adhere to these metrics.

What is the registered adherence to time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of airway device placement in trachea in the ICU setting?

This was a retrospective analysis. Using the Get With The Guidelines-Resuscitation registry, adult patients with an index cardiac arrest in adult ICUs between 2006 and 2018 in the United States were identified. Modified Poisson regression with generalized estimation equations were used for the analyses.

A total of 97,009 adult ICU patients from 538 hospitals were identified using the Get With The Guidelines-Resuscitation registry, and 75,668 patients were included in the final analysis. From 2006 to 2018, adherence to time to epinephrine ≤ 5 min increased from 93% (95% CI, 93-94) to 98% (95% CI, 97-98), time to defibrillation ≤ 2 min increased from 72% (95% CI, 69-75) to 75% (95% CI, 72-78), and confirmation of airway device placement in trachea increased from 93% (95% CI, 91-94) to 97% (95% CI, 96-98). Nonwitnessed status (P < .001), nonmonitored status (P = .003), and nighttime arrest (P = .002) were associated with adherence failure for time to epinephrine ≤ 5 min, whereas a noncardiac (P < .001) or traumatic (P < .001) illness category, renal insufficiency (P = .001), and nighttime arrest (P = .03) were associated with adherence failure for time to defibrillation ≤ 2 min.

Overall, quality metric adherence was high in the ICU, with the exception of time to defibrillation ≤ 2 min.

Our aim was to determine the association of cardiopulmonary resuscitation (CPR) for in hospital cardiac arrest (IHCA) with quality of life after discharge.

We performed a systematic review using available databases for studies that measured any quality-of-life or functional outcome both before and after CPR for IHCA. All screening and data abstraction was performed in duplicate.

We screened 10,927 records and included 24 papers representing 20 unique studies. Fifteen studies measured Cerebral Performance Category. Survival ranged from 11.8% to 39.5%. The risk of impaired cerebral function after discharged ranged from −16.1% (lower risk) to 44.7% increased risk of poor cerebral function after surviving to discharge. Four studies measured discharge to an institutional environment finding that the risk was increased by 18.2–72.2% among survivors. One study measured EQ-5D and found no difference pre and post CPR. One study measured performance of activities of daily living finding that survivors needed assistance with more activities after discharge.

Our review is limited by the lack of adjustment for confounders, including the baseline level of each outcome, in all included studies. Therefore, although risk for most outcomes was increased after discharge vs pre-admission we cannot be certain if this is a causal relationship.

In-hospital cardiac arrest (IHCA) is a common clinical event with poor outcomes. Former IHCA registries in China were local, inconsistent in data reporting, and lacked attention to the process of care. Therefore, we designed and implemented the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA), the first national IHCA registry in China.

BASIC-IHCA is a prospective, multicenter, observational study with a nationwide surveillance network covering urban and rural hospitals from seven geographic regions of China. IHCA patients were enrolled continuously, and data were collected from medical records by investigators at participating hospitals. Key variables referring to the updated Utstein Template included patient information, event variables, process of care, and outcomes. Follow-up was conducted by telephone interview to obtain details on long-term survival and neurological status.

Thirty-two urban hospitals and eight rural hospitals from twenty-nine provinces in seven geographic regions of China participated in BASIC-IHCA. The starting time of enrollment ranged from July 1, 2019, to January 1, 2020. By December 31, 2020, 35,451 IHCAs were enrolled in all participating hospitals, of which 19,493 (55%) received CPR, with a predominance of males (65%) and a median age of 65 years.

BASIC-IHCA is the first national registry for IHCA in China. It will describe the epidemiology and outcomes of IHCA from a nationwide perspective, with a particular focus on details of the process of care for quality improvement. Meanwhile, it will help to facilitate the standardization of IHCA-related data reporting in China.

Utstein Abbey near Stavanger in Norway, hosted a meeting in 1990 on guidelines for the uniform reporting of data from out-of-hospital cardiac arrest. In this paper we describe the last 30 years of the Utstein style.

A systematic literature search identified publications from Utstein-style meetings or groups using the Utstein format.

30 outputs were found, describing primarily resuscitation structure, process and outcome measures. They originated from all over the world and from multiple medical disciplines. Some were co-published in multiple journals.

The meeting at Utstein Abbey in 1990 has had a sustained and far-reaching impact, particularly in resuscitation science, implementation and outcomes. The Utstein format will continue to evolve following the key principles from the original meeting and with the ultimate aim of improving patient care and outcomes.