Preceding national early warnings scores among in-hospital cardiac arrests and their impact on survival.

OBJECTIVES

In-hospital cardiac arrests (IHCAs) are often preceded by abnormal vital signs. Preceding abnormal vital signs might lower the physiological reserve capacity and therefore decrease survival after an IHCA.

AIM

To assess the preceding national early warning score (NEWS) and its relation to survival after an IHCA.

MATERIAL AND METHODS

All patients ≥18years suffering an IHCA at Karolinska University Hospital between 1st January 2014 and 31st December 2015 were included. Data regarding the IHCA, patient characteristics, calculated NEWS and 30-day survival were obtained from electronic patient records. Parameters included in NEWSs were assessed up to 12h before the IHCA. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with NEWSs of 0-4 points (low) versus those with at least 5 points (moderate) and 7 points (high). Adjustments included hospital site, sex, co-morbidities, first rhythm and location of the IHCA.

RESULTS

In all, 358 patients suffered an IHCA, of whom 109 (30%) survived at least 30days and 296 (83%) had sufficient vital sign documentation to calculate NEWS before the IHCA. The 87 patients with a medium NEWS had a fourfold chance and those 78 with a high NEWS (22%) had an almost tenfold chance of dying after the IHCA compared to those with a low NEWS (Adjusted OR 4.43, 95% CI 1.81-10.83 and OR 9.88 95% C.I. 2.77-35.26, respectively).

CONCLUSION

The NEWS can be a probable proxy for estimating physiological reserve capacity since high NEWS is associated to high change of death in case of an IHCA. This information can be used when discussing prognosis with patients and relatives. But even more importantly, it stresses the need for better preventive strategies in IHCAs. STRENGTHENS AND LIMITATIONS WITH THIS STUDY.