Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

Background Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared to daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed. Objective To examine temporal trends in survival differences between on-hours and off-hours IHCA. Methods We identified 151,071 adults at 470 U.S. hospitals in the Get with the Guidelines–Resuscitation registry during 2000–2014. Using multivariable logistic regression with generalized estimating equations, we examined whether survival trends in IHCA differed during on-hours (Monday–Friday 7:00 a.m.–10:59 p.m.) vs. off-hours (Monday–Friday 11:00 p.m.–6:59 a.m., and Saturday-Sunday, all day). Results Among 151,071 participants, 79,091 (52.4%) had an IHCA during off-hours. Risk-adjusted survival improved over time in both groups (on-hours: 16.0% in 2000, 25.2% in 2014; off-hours: 11.9% in 2000, 21.9% in 2014; P for trend <.001 for both). However there was no significant change in the survival difference over time between on-hours and off-hours, either on an absolute (P=0.75) or a relative scale (P=0.059). Acute resuscitation survival improved significantly in both groups (on-hours: 56.1% in 2000, 71% in 2014; off-hours: 46.9% in 2000, 68.2% in 2014; P for trend <.001 for both) and the difference between on-hours and off-hours narrowed over time (P = 0.02 absolute scale, P<.001 relative scale). In contrast, although post-resuscitation survival also improved over time in both groups (P for trend <.001 for both), the absolute and relative difference persisted. Conclusions Despite an overall improvement in survival, lower survival in IHCA during off-hours compared to on-hours persist.