In-hospital cardiac arrest: from epidemiology to bedside.
Keywords:cardiac arrest, intrahospital, epinephrine, therapeutic hypothermia, prognosis
In-hospital cardiac arrest (IHCA) is a rare event (approximately 1 case per 1000 hospital admissions) but associated with significant mortality and morbidity. Many elements of management are modeled on out-of-hospital cardiac arrest and/or the immediate availability of a full hospital technical platform.
Prevention, including improved detection of IHCA, but also prediction of their occurrence, requires the establishment of exhaustive registries such as those that already exist in Scandinavian countries, but which is lacking in France in 2021.
The causes of IHCA are balanced between cardiac causes similar to out of hospital cardiac arrest (OHCA) and extracardiac causes, with asphyxia as the main cause. This epidemiology leads to a specific management in a more frequent way than for OHCA. Non-specialized management (basic life support) is based on chest compressions, oxygenation with or without tracheal intubation and administration of epinephrine.
Management after recovery of spontaneous cardiac activity is guided by the etiology and neuroprotective measures that may be offered. The evaluation of the prognosis being crucial as in the OHCA before nevertheless a particular place for the comorbidities, the fragility and the pathology responsible for the hospital stay.