The incidence, predictors, and causes of cardiac arrest in United States emergency departments

Shu-Hsien Hsu; Chih-Wei Sung; Tsung-Chien Lu; Chih-Hung Wang; Eric H Chou; Chia-Hsin Ko; Chien-Hua Huang; Chu-Lin Tsai

doi:10.1016/j.resplu.2023.100514

The incidence, predictors, and causes of cardiac arrest in United States emergency departments

Resusc Plus. 2023 Nov 24:17:100514. doi: 10.1016/j.resplu.2023.100514. eCollection 2024 Mar.

Authors

Shu-Hsien Hsu^{1

2}, Chih-Wei Sung³, Tsung-Chien Lu^{1

2}, Chih-Hung Wang^{1

2}, Eric H Chou⁴, Chia-Hsin Ko¹, Chien-Hua Huang^{1

2}, Chu-Lin Tsai^{1

2}

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
⁴ Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, TX, USA.

Abstract

Background: Emergency department cardiac arrest (EDCA) is a global public health challenge associated with high mortality rates and poor neurological outcomes. This study aimed to describe the incidence, risk factors, and causes of EDCA during emergency department (ED) visits in the U.S.

Methods: This retrospective cohort study used data from the 2019 Nationwide Emergency Department Sample (NEDS). Adult ED visits with EDCA were identified using the cardiopulmonary resuscitation code. We used descriptive statistics and multivariable logistic regression, considering NEDS's complex survey design. The primary outcome measure was EDCA incidence.

Results: In 2019, there were approximately 232,000 ED visits with cardiac arrest in the U.S. The incidence rate of EDCA was approximately 0.2%. Older age, being male, black race, low median household income, weekend ED visits, having Medicare insurance, and ED visits in non-summer seasons were associated with a higher risk of EDCA. Hispanic race was associated with a lower risk of EDCA. Certain comorbidities (e.g., diabetes and cancer), trauma centers, hospitals with a metropolitan and/or teaching program, and hospitals in the South were associated with a higher risk of EDCA. Depression, dementia, and hypothyroidism were associated with a lower risk of EDCA. Septicemia, acute myocardial infarction, and respiratory failure, followed by drug overdose, were the predominant causes of EDCA.

Conclusions: Some patients were disproportionately affected by EDCA. Strategies should be developed to target these modifiable risk factors, specifically factors within ED's control, to reduce the subsequent disease burden.

Keywords: Cardiac arrest; Cause; Emergency department; Incidence; Risk factor.