Non-shockable rhythm and the presence of a potentially reversible cause were consistently associated with outcomes following IHCA, while active hematologic malignancy was associated with poorer longer-term survival.
Key Findings
Results
Sustained return of spontaneous circulation (ROSC) lasting >20 minutes was achieved in 91 of 134 patients (67.9%) following in-hospital cardiac arrest.
Study included 134 adults with confirmed IHCA requiring cardiopulmonary resuscitation at a tertiary university hospital between 2011 and 2015.
33 patients (24.6%) survived to day 28 and 30 patients (22.4%) survived to day 60.
Single-center retrospective cohort design at a university hospital with advanced tertiary and transplant care.
Sustained ROSC was defined as lasting more than 20 minutes.
Results
Initial non-shockable rhythm was associated with lower odds of sustained ROSC and 28-day survival, and with higher 60-day mortality.
Non-shockable rhythm was associated with lower odds of sustained ROSC (aOR 0.26, 95% CI 0.09–0.69).
Non-shockable rhythm was associated with lower odds of 28-day survival (aOR 0.27, 95% CI 0.10–0.68).
Non-shockable rhythm was associated with higher 60-day mortality (aHR 1.96, 95% CI 1.25–3.08).
Analyses used parsimonious Firth penalized logistic regression models for sustained ROSC and 28-day survival, and Cox proportional hazards regression for 60-day mortality.
Results
The presence of a potentially reversible cause of cardiac arrest was associated with more favorable outcomes.
Potentially reversible cause was a predictor included in adjusted regression models for both sustained ROSC and 28-day survival.
This finding was described as consistent across outcome measures.
The authors note this finding requires confirmation in contemporary multicenter cohorts.
Specific odds ratios for this variable were not individually cited in the abstract but were included in adjusted models.
Results
Active hematologic malignancy was associated with higher 60-day mortality following in-hospital cardiac arrest.
Active hematologic malignancy was associated with higher 60-day mortality (aHR 1.89, 95% CI 1.15–3.10).
This finding was identified in Cox proportional hazards regression adjusted for other covariates.
The study was conducted at a tertiary center with advanced transplant care, a setting where hematologic malignancy patients are commonly treated.
The authors note this finding requires confirmation in larger multicenter studies.
Results
In exploratory analyses, initially dilated pupils were associated with lower 28-day survival after in-hospital cardiac arrest.
Pupillary assessment at the time of arrest was examined as an exploratory neurological marker.
Initially dilated pupils were associated with lower 28-day survival in exploratory analyses.
The authors explicitly designated neurological and biomarker analyses as exploratory.
These findings were noted to require confirmation and do not constitute validated clinical prediction tools.
Results
Higher lactate levels were associated with 60-day mortality in exploratory analyses.
Lactate was examined as a metabolic biomarker in exploratory analyses.
Higher lactate was associated with 60-day mortality in adjusted models.
The authors describe lactate as potentially providing 'complementary prognostic information.'
Specific lactate thresholds or exact effect estimates were not provided in the abstract.
Results
Among patients who survived beyond 24 hours, higher BNP levels were associated with subsequent mortality.
BNP analysis was limited to the subset of patients who survived beyond 24 hours post-arrest.
Higher BNP was associated with subsequent mortality in this survivor subgroup.
The authors explicitly note the BNP analysis was limited by its restriction to 24-hour survivors, which introduces survivor bias.
BNP was described as potentially offering complementary prognostic information alongside lactate and pupillary assessment.
What This Means
This research examined what factors predict survival after cardiac arrest that occurs inside a hospital, using data from 134 patients treated at a German university hospital with specialized transplant care between 2011 and 2015. The study found that overall outcomes were poor: while about two-thirds of patients achieved a sustained return of heartbeat after resuscitation, only about 1 in 4 survived to 28 days, and roughly 1 in 5 was still alive at 60 days. The type of abnormal heart rhythm at the time of arrest was one of the strongest predictors—patients whose hearts were in a 'non-shockable' rhythm (meaning a defibrillator shock would not help) were far less likely to survive than those with a rhythm that could be shocked back to normal.
The study also found that when doctors could identify a specific, treatable cause for the cardiac arrest, patients tended to do better. On the other hand, patients who had an active blood cancer (hematologic malignancy) were nearly twice as likely to die within 60 days compared to other patients. Exploratory analyses suggested that having dilated pupils at the time of arrest, higher blood lactate levels (a marker of poor oxygen delivery), and higher BNP levels (a marker of heart stress, measured only in those who survived the first 24 hours) were each linked to worse outcomes, though these findings are considered preliminary.
This research suggests that the initial heart rhythm and whether a reversible cause can be identified are key early indicators of who is likely to survive a hospital cardiac arrest. The finding that active blood cancer significantly worsens outcomes may be relevant for discussions about resuscitation decisions in this patient group. However, the authors caution that this was a relatively small, single-center study from over a decade ago, and these findings need to be confirmed in larger, more recent studies before they can be used as formal clinical decision-making tools.
Nashtar M, Nekarda P, Varnavas V, Tzalavras A, Best J, Canbay A, et al.. (2026). Predictors and Outcomes of In-Hospital Cardiac Arrest in University Medicine with Advanced Tertiary and Transplant Care.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14040480