Chang Feng-Cheng, Hsieh Ming-Jer, Yeh Jih-Kai, Wu Victor Chien-Chia, Cheng Yu-Ting, Chou An-Hsun, Lin Chia-Pin, Ng Chip-Jin, Chen Shao-Wei, Chen Chun-Yu
Department of Anesthesiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fusing St, Guishan District, Taoyuan City, 33305, Taiwan.
Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
Crit Care. 2025 Jan 23;29(1):41. doi: 10.1186/s13054-025-05274-1.
In-hospital cardiac arrest (IHCA) poses a considerable threat to hospitalized patients, leading to high mortality rates and severe neurological deficits among survivors. Despite the advancements in resuscitation practices, the prognosis of IHCA remains poor, and comprehensive studies exploring nationwide trends and long-term survival are scarce, particularly in the Asian populations.
Utilizing data from the Taiwan National Health Insurance Research Database, we conducted a nationwide cohort study to analyze the IHCA events among adult patients between 2003 and 2020. The outcomes of interest in this study included the temporal trend in the IHCA incidence, in-hospital mortality, and median survival after discharge for overall hospitalizations.
Over the 18-year period, the IHCA incidence in Taiwan declined by 70%, from an annual incidence of 7.1 per 1,000 admissions to a lower rate in 2020, accompanied by a 14% reduction in the in-hospital mortality rate, with an average of 86.5%. The overall long-term survival rate for discharged survivors was 63.9%. We observed a substantial 125% increase in the median survival duration of discharged survivors, rising from 1.56 years in 2003 to 3.51 years in 2015. Favorable in-hospital survival rates and extended life expectancy were notably seen in the patients with shockable rhythms, those with a cardiac primary diagnosis, women, and younger patients.
Our study data revealed significant declines in the IHCA incidence and in-hospital mortality in Taiwan, along with improved long-term survival among survivors, particularly among specific subgroups. Women exhibited significantly better long-term survival as compared to men, underscoring the need to avoid sex-based treatment biases. Improvements in discharge survival rates and life expectancy were less pronounced in older survivors, indicating that age alone may not be sufficient to guide IHCA management decisions. Proactive resuscitation should be carefully considered for older patients, particularly those with mild frailty and potentially reversible conditions. Trial registration the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (Registration number: 202301625B0, Registered 7 November 2023).
院内心脏骤停（IHCA）对住院患者构成了相当大的威胁，导致高死亡率以及幸存者中出现严重的神经功能缺损。尽管复苏实践有所进步，但IHCA的预后仍然很差，而探索全国趋势和长期生存情况的综合研究很少，尤其是在亚洲人群中。
利用台湾全民健康保险研究数据库的数据，我们开展了一项全国性队列研究，以分析2003年至2020年成年患者中的IHCA事件。本研究关注的结果包括IHCA发病率的时间趋势、住院死亡率以及所有住院患者出院后的中位生存期。
在这18年期间，台湾的IHCA发病率下降了70%，从每1000例入院患者中每年发病7.1例降至2020年的较低水平，同时住院死亡率降低了14%，平均为86.5%。出院幸存者的总体长期生存率为63.9%。我们观察到出院幸存者的中位生存时间大幅增加了125%，从2003年的1.56年增至2015年的3.51年。在可电击心律患者、以心脏疾病为主要诊断的患者、女性以及年轻患者中，观察到了良好的住院生存率和延长的预期寿命。
我们的研究数据显示，台湾的IHCA发病率和住院死亡率显著下降，幸存者的长期生存情况有所改善，尤其是在特定亚组中。与男性相比，女性的长期生存率显著更高，这凸显了避免基于性别的治疗偏见的必要性。老年幸存者出院生存率和预期寿命的改善不太明显，这表明仅年龄因素可能不足以指导IHCA的管理决策。对于老年患者，尤其是那些轻度虚弱且可能有可逆情况的患者，应谨慎考虑积极的复苏措施。试验注册 长庚纪念医院机构审查委员会批准了所有数据使用和研究方案（注册号：202301625B0，于2023年11月7日注册）。
