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Night and Day: Differences in Survival of In-Hospital Cardiac Arrest

Data from a large registry reveal decreased rates of survival to discharge after events that occurred at night or on weekends.

Authors of a recent study identified a high frequency of delays in defibrillation after in-hospital cardiac arrest and described the adverse effects of such delays on patient outcomes (Journal Watch Cardiology Jan 2 2008). Now, using data from the same national registry, other investigators have determined whether the time of day and day of week of in-hospital cardiac arrests affect patient outcomes.

The study included 86,748 events at 507 hospitals from January 2000 through January 2007. Patients whose arrests occurred during the daytime or evening (7:00 AM–10:59 PM) on weekdays had a significantly higher rate of survival to discharge than those whose arrests occurred at night (11:00 PM–6:59 AM; adjusted odds ratio, 1.18). They were also significantly more likely to have return of spontaneous circulation for >20 minutes (AOR, 1.15) and a favorable neurological outcome (AOR, 1.17). The emergency department was the only hospital location, and trauma the only illness category, in which circadian differences in survival were not significant. The survival-to-discharge rate for events occurring at night on weekends was similar to that for events occurring on weeknights. Events occurring during weekend days, however, were associated with lower survival than were events occurring during weekdays (OR, 1.15). These differences were unaffected by type of arrest, monitored status, time to defibrillation, and many other potential confounders.

Comment: In this study, survival after an in-hospital cardiac arrest was better during the day or evening and on weekdays than at night and on weekends. It is not clear why this was so, and whether opportunities for improvement exist. The analysis could not account for all possible confounders or any pertinent but unidentified hospital quality issues. We cannot make any recommendations from these results, but they should stimulate us to look closely at how we care for patients with cardiac arrest in our institutions.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology February 19, 2008

Citation(s):

Peberdy MA et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008 Feb 20; 299:785.

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