Therapeutic Outcomes of In-Hospital Resuscitation of Patients Admitted to the Internal Medicine Wards

In-hospital cardiac arrest is a common phenomenon associated with high mortality rates. In the United States, 290,000 cases of in-hospital cardiac arrest among adult patients occur annually (1). The mean patient age is 66 years, and 58% are male. In the majority of cases (81%), the initial cardiac rhythm was non-shockable (asystole, PEA). The primary cause of arrest was cardiac (50-60%), followed by respiratory causes (15-40%) (1). Survival rates for these patients have risen over the past two decades; according to the GWTG-R registry, survival to hospital discharge was 25% in 2017, with 85% of survivors demonstrating a favorable neurological outcome (CPC score of 1 or 2; see details under "Objectives"). It is important to note that these figures vary across different countries, potentially due to differences in the patient populations studied (e.g., survival odds are better for cardiac-related arrest than for respiratory-related arrest; distinctions between internal medicine, surgical, cardiac, and trauma patients; the location of resuscitation-ICU vs. general ward, etc.) as well as cultural, social, and religious factors (e.g., awareness of DNR/DNI orders among the public and medical staff, specific national legislation, and patient preferences). ...the patient and their family regarding end-of-life care due to religious, cultural, or social reasons, etc.).

The GO FAR score (Good Outcome Following Attempted Resuscitation) is a clinical prediction tool that estimates the likelihood of survival to hospital discharge with a good neurological outcome (CPC score of 1) for patients who have undergone in-hospital resuscitation. This score was developed using data from 51,000 patients across 366 hospitals, based on the GWTG-R registry. It incorporates data known prior to cardiac arrest, enabling the medical team, the patient, and the family to formulate a plan in advance regarding the course of action should the patient experience in-hospital cardiac arrest. The data points include age, neurological status upon admission, multisystem trauma, acute stroke, hematologic-oncologic disease or metastatic cancer, sepsis with bacteremia, non-cardiac reason for admission, liver failure, admission from a nursing facility, hypotension or shock upon admission, renal failure, respiratory failure, and pneumonia upon admission. Subsequently, the GO FAR 2 score was developed; while it included the same data points, it slightly modified the scoring method and also incorporated a CPC score of 2 (2,3).

We aim to examine survival rates to discharge with a good neurological outcome following in-hospital resuscitation... At Meir Hospital, we are focusing on a specific patient population: those hospitalized in internal medicine wards. This group generally has a lower likelihood of surviving with intact neurological function (due to factors such as advanced age, non-cardiac causes of arrest, and parameters contributing to a "GO FAR" score that reflects a poor prognosis). Our working hypothesis is that the success rate of resuscitation for these patients is typically very low; attempting it may cause suffering to the patient and their family without offering a reasonable chance of survival with a favorable neurological outcome. Beyond this point-which we consider paramount for the patient-resuscitation attempts with poor prospects entail other consequences: financial costs, extended hospital stays, increased workload for medical and nursing staff, and reduced resource availability for other patients with better recovery prospects, among others. Carefully selecting patients with a higher likelihood of successful in-hospital resuscitation would not only improve outcomes but also prevent unnecessary suffering. To formulate a plan for the informed selection of these patients, this study aims to collect relevant data.