Is the risk of dying from an in-hospital cardiac arrest increased at night and on weekends?

Adults suffering an in-hospital cardiac arrest have a better chance of survival and a favorable neurologic outcome if the cardiac arrest occurs during day or evening hours on weekdays; that is, not at night or on the weekends. This should come as no surprise to nurse managers struggling to obtain funding to adequately staff their clinical wards. (LOE = 1b)

Peberdy MA, Ornato JP, Larkin GL, et al, for the National Registry of Cardiopulmonary Resuscitation Investigators. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008;299(7):785-792.  [PMID:18285590]

Cohort (prospective)

Foundation

Inpatient (any location) with outpatient follow-up

These investigators obtained information from the National Registry of Cardiopulmonary Resuscitation that comprises reports from 507 participating hospitals in the United States. From January 1, 2000, through February 1, 2007, all consecutive adult in-hospital cardiac arrest events (N = 86,748) were included in the analysis. The rate of survival to discharge, survival at 24 hours, and favorable neurologic outcome were all significantly lower with in-hospital cardiac arrests occurring during the night compared with day or evening hours. Survival for cardiac arrests occurring during day or evening hours was also significantly higher during the weekdays than on weekends. The first cardiac rhythm at night was more frequently asystole and less frequently ventricular fibrillation, possibly suggesting a significantly increased time from the actual arrest to the time of attempted resuscitation.