BackgroundDespite advances in resuscitation medicine, the burden of in‐hospital cardiac arrest (IHCA) remains substantial. The impact of these advances and changes in resuscitation guidelines on IHCA survival remains poorly defined. To better characterize evolving patient characteristics and temporal trends in the nature and outcomes of IHCA, we undertook a 20‐year analysis of a national database.Methods and ResultsWe analyzed the National Inpatient Sample (1999–2018) using International Classification of Diseases, Ninth Revision and Tenth Revision, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) codes to identify all adult patients suffering IHCA. Subgroup analysis was performed based on the type of cardiac arrest (ie, ventricular tachycardia/ventricular fibrillation or pulseless electrical activity‐asystole). An age‐ and sex‐adjusted model and a multivariable risk‐adjusted model were used to adjust for potential confounders. Over the 20‐year study period, a steady increase in rates of IHCA was observed, predominantly driven by pulseless electrical activity‐asystole arrest. Overall, survival rates increased by over 10% after adjusting for risk factors. In recent years (2014–2018), a similar trend toward improved survival is noted, though this only achieved statistical significance in the pulseless electrical activity‐asystole cohort.ConclusionsThough the ideal quality metric in IHCA is meaningful neurological recovery, survival is the first step toward this. As overall IHCA rates rise, overall survival rates are improving in tandem. However, in more recent years, these improvements have plateaued, especially in the realm of ventricular tachycardia/ventricular fibrillation‐related survival. Future work is needed to better identify characteristics of IHCA nonsurvivors to improve resource allocation and health care policy in this area.

中文翻译：

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与院内心脏骤停相关的特征和结果的时间趋势：20 年分析（1999-2018）

背景尽管复苏医学取得了进展，但院内心脏骤停 (IHCA) 的负担仍然很大。这些进展和复苏指南的变化对 IHCA 生存率的影响仍未明确。为了更好地描述 IHCA 的性质和结果中不断变化的患者特征和时间趋势，我们对国家数据库进行了 20 年的分析。方法和结果我们使用国际疾病分类第九版分析了国家住院患者样本（1999-2018 ）和第十次修订，临床修改（ICD-9-CM和ICD-10-CM) 代码来识别所有患有 IHCA 的成年患者。根据心脏骤停的类型（即室性心动过速/心室颤动或无脉搏电活动-心搏停止）进行亚组分析。使用年龄和性别调整模型和多变量风险调整模型来调整潜在的混杂因素。在 20 年的研究期间，观察到 IHCA 发生率稳步上升，主要由无脉冲电活动心搏停止驱动。总体而言，在调整风险因素后，存活率增加了 10% 以上。近年来（2014-2018 年），人们注意到类似的提高生存率的趋势，尽管这仅在无脉冲电活动-心搏停止队列中取得了统计学意义。结论虽然 IHCA 中的理想质量指标是有意义的神经恢复，生存是实现这一目标的第一步。随着总体 IHCA 率的上升，总体生存率也在同步提高。然而，近年来，这些改善已趋于平稳，尤其是在室性心动过速/心室颤动相关生存率方面。未来的工作需要更好地识别 IHCA 非幸存者的特征，以改善该领域的资源分配和医疗保健政策。