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Emergency Medicine881 papers

In-hospital cardiac arrest

Last edited: 4/13/2026

Overview

In-hospital cardiac arrest (IHCA) refers to sudden cessation of cardiac mechanical activity requiring resuscitation within a healthcare facility, posing significant mortality and morbidity risks 2333.

Diagnosis

  • Rapid identification through clinical assessment and monitoring tools 23.
  • Electrocardiogram (ECG) essential for determining rhythm and guiding resuscitation 33.
  • Confirmation of absence of circulation and breathing 23.

    • Management

  • First-line treatments:
    • - High-quality cardiopulmonary resuscitation (CPR) 23. - Early defibrillation for shockable rhythms (VF/VT) 23.
  • Medications:
    • - Epinephrine (repeated doses) 23. - Amiodarone or lidocaine for refractory VF/VT 23.
  • Advanced interventions:
    • - Rapid response team activation 223. - Post-resuscitation care including therapeutic hypothermia 23.

    Special Populations

  • Elderly: Higher risk of adverse outcomes; tailored post-resuscitation care is crucial 19.
  • Comorbidities: Presence of chronic conditions like heart failure or renal impairment may influence treatment choices and outcomes 19.

    • Key Recommendations

  • Implement high-quality CPR with minimal interruptions 23 (Evidence: Strong).
  • Initiate early defibrillation for shockable rhythms 23 (Evidence: Strong).
  • Use epinephrine early and repeatedly during resuscitation 23 (Evidence: Strong).
  • Consider therapeutic hypothermia post-resuscitation for improved neurological outcomes 23 (Evidence: Moderate).
  • Tailor post-arrest care considering patient comorbidities and age 19 (Evidence: Moderate).
  • Activate rapid response systems promptly to address underlying causes 2 (Evidence: Moderate).

    • References

    1 Bekiroglu Ergun T, Akben M, Ergun Y, Altıntaş Aykan D. Knowledge, attitude and practices regarding pharmacovigilance among Turkish inpatients: A cross-sectional study. Pakistan journal of pharmaceutical sciences 2026. link 2 Seyghalani Talab F, Ahadinezhad B, Khosravizadeh O, Amerzadeh M. A model of the organizational resilience of hospitals in emergencies and disasters. BMC emergency medicine 2024. link 3 Kim M, Choi J, Jo JY, Kim WJ, Kim SH, Kim N. Video-based automatic hand hygiene detection for operating rooms using 3D convolutional neural networks. Journal of clinical monitoring and computing 2024. link 4 Schrepel C, Amick AE, Bann M, Watsjold B, Jauregui J, Ilgen JS et al.. Who's on your team? Specialty identity and inter-physician conflict during admissions. Medical education 2022. link 5 Medarević A. Performance evaluation of general public hospitals in territories of the Former Yugoslavia: An ecological study using the Pabon Lasso model. The International journal of health planning and management 2022. link 6 Zhang B, Wu XL, Li R. A Meta-Analysis on Evaluation of Nosocomial Infections Amongst Patients in a Tertiary Care Hospital. Journal of healthcare engineering 2021. link 7 Abumettleq ISS, Bayraktar N. Nurses' awareness on hospital acquired infection risks of the geriatric patients: A descriptive and cross-sectional study. Journal of infection in developing countries 2021. link 8 Uda K, Funaki T, Shoji K, Kato A, Miyairi I. High proportion of multidrug-resistant organisms in children hospitalized abroad. American journal of infection control 2020. link 9 Sundermann AJ, Babiker A, Marsh JW, Shutt KA, Mustapha MM, Pasculle AW et al.. Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional Radiology: Detection Through Whole-genome Sequencing-based Surveillance. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2020. link 10 Magill N, White IR, Walker J, Burke K, Toynbee M, van Niekerk M et al.. The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the  time spent in hospital by older acute hospital inpatients. Trials 2020. link 11 Uitvlugt EB, Janssen MJA, Siegert CEH, Leenders AJA, van den Bemt BJF, van den Bemt PMLA et al.. Patients' and providers' perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge. Health expectations : an international journal of public participation in health care and health policy 2020. link 12 Soelch LA, Repp AB. Hospital Responses to Mortality Measures: A Survey of Hospital Administrative Leaders. Quality management in health care 2019. link 13 Mirza I, AbdelWareth LO, Liaqat M, Anderson P, Palmer B, Turner A et al.. Establishing a Clinical Laboratory in a Tertiary/Quaternary Care Greenfield Hospital in the Middle East: Recounting the Cleveland Clinic Abu Dhabi Experience. Archives of pathology & laboratory medicine 2018. link 14 Brittan MS, Martin S, Anderson L, Moss A, Torok MR. An Electronic Health Record Tool Designed to Improve Pediatric Hospital Discharge has Low Predictive Utility for Readmissions. Journal of hospital medicine 2018. link 15 Wright JR. The American College of Surgeons, Minimum Standards for Hospitals, and the Provision of High-Quality Laboratory Services. Archives of pathology & laboratory medicine 2017. link 16 Johnsen H. Professional responses to post bureaucratic hospital reforms and their impact on care provision. Women and birth : journal of the Australian College of Midwives 2015. link 17 Tsapaki V, Bayford R. Medical Physics: Forming and testing solutions to clinical problems. Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) 2015. link 18 Zadeh R, Sadatsafavi H, Xue R. Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes. HERD 2015. link 19 Wakabayashi H, Sashika H. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. Journal of rehabilitation medicine 2014. link 20 Olson CH, Dierich M, Adam T, Westra BL. Optimization of decision support tool using medication regimens to assess rehospitalization risks. Applied clinical informatics 2014. link 21 Parikh S, Christensen D, Stuchbery P, Peterson J, Hutchinson A, Jackson T. Exploring in-hospital adverse drug events using ICD-10 codes. Australian health review : a publication of the Australian Hospital Association 2014. link 22 Armadans-Gil L, Rodríguez-Garrido V, Campins-Martí M, Gil-Cuesta J, Vaqué-Rafart J. Particle counting and microbiological air sampling: results of the simultaneous use of both procedures in different types of hospital rooms. Enfermedades infecciosas y microbiologia clinica 2013. link 23 O'Leary KJ, Devisetty VK, Patel AR, Malkenson D, Sama P, Thompson WK et al.. Comparison of traditional trigger tool to data warehouse based screening for identifying hospital adverse events. BMJ quality & safety 2013. link 24 Meinke R, Meyer B, Frei R, Passweg J, Widmer AF. Equal efficacy of glucoprotamin and an aldehyde product for environmental disinfection in a hematologic transplant unit: a prospective crossover trial. Infection control and hospital epidemiology 2012. link 25 Melaku S, Gebre-Selassie S, Damtie M, Alamrew K. Hospital acquired infections among surgical, gynaecology and obstetrics patients in Felege-Hiwot referral hospital, Bahir Dar, northwest Ethiopia. Ethiopian medical journal 2012. link 26 . Teach-back program reduces readmissions. Healthcare benchmarks and quality improvement 2011. link 27 Bunting RF. Calculating the frequency of serious reportable adverse events and hospital-acquired conditions. Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management 2010. link 28 Ouchida K, LoFaso VM, Capello CF, Ramsaroop S, Reid MC. Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings. Journal of the American Geriatrics Society 2009. link 29 Carlet J, Fabry J, Amalberti R, Degos L. The "zero risk" concept for hospital-acquired infections: a risky business!. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2009. link 30 López L, Weissman JS, Schneider EC, Weingart SN, Cohen AP, Epstein AM. Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. Archives of internal medicine 2009. link 31 Ferrand E, Jabre P, Vincent-Genod C, Aubry R, Badet M, Badia P et al.. Circumstances of death in hospitalized patients and nurses' perceptions: French multicenter Mort-a-l'Hôpital survey. Archives of internal medicine 2008. link 32 Jarman B. In defence of the hospital standardized mortality ratio. HealthcarePapers 2008. link 33 Sari AB, Sheldon TA, Cracknell A, Turnbull A, Dobson Y, Grant C et al.. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Quality & safety in health care 2007. link 34 Olsen S, Neale G, Schwab K, Psaila B, Patel T, Chapman EJ et al.. Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place. Quality & safety in health care 2007. link 35 Akcam FZ, Karaaslan D, Dogan M, Yayli G. Microbiological surveillance in the intensive care unit: a tertiary hospital experience. Medical science monitor : international medical journal of experimental and clinical research 2006. link 36 Le Clerc S. Preparing for the Diploma in Immediate Medical Care of the Royal College of Surgeons of Edinburgh. Accident and emergency nursing 2005. link 37 Kucukates E. Antimicrobial resistance among Gram-negative bacteria isolated from intensive care units in a Cardiology Institute in Istanbul, Turkey. Japanese journal of infectious diseases 2005. link 38 Fisher C, Fiorilli MG. Commentary: applying hospital quality indicators to clinical practice. American journal of medical quality : the official journal of the American College of Medical Quality 2001. link 39 Himes SM. The collision of healthcare and corporate law in a hospital closure case. Journal of health law 2001. link 40 Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals. Pharmacotherapy 2000. link 41 Wachter RM. The hospitalist movement: ten issues to consider. Hospital practice (1995) 1999. link 42 Torfoss D, Aukrust P, Brinch L, Mathiesen O, Simonsen GS, Axelsen AK et al.. Carrier rate of resistant enterococci in a tertiary care hospital in Norway. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica 1999. link 43 Calkins ER. Nosocomial infections in hand surgery. Hand clinics 1998. link 44 Meyer H. Focused factories. Are you ready for the competition?. Hospitals & health networks 1998. link 45 Lutz S. They're the best at keeping a lid on costs. Modern healthcare 1995. link 46 Wooldridge J, Cheh V, Thompson R, Moreno L, Holden N. Do transition grants help rural hospitals?. Health care financing review 1995. link 47 Rigby E. The Yale Cost Model and cost centres: servant or master?. Australian health review : a publication of the Australian Hospital Association 1993. link 48 Momtahan K, Hétu R, Tansley B. Audibility and identification of auditory alarms in the operating room and intensive care unit. Ergonomics 1993. link 49 O'Connell P. Role statement: one hospital's experience. Healthcare management forum 1991. link61242-2) 50 Bancroft ML, du Moulin GC, Hedley-Whyte J. Hazards of hospital bulk oxygen delivery systems. Anesthesiology 1980. link 51 Kocka FE, Roemisch E, Causey WA, O'Dell A. The urometer as a reservoir of infectious organisms. American journal of clinical pathology 1977. link 52 Holloway DC, Holton JP, Goldberg GA, Restuccia JD. Development of hospital levels of care criteria. Health care management review 1976. link 53 Martin A, Millard PH. The New Patient Index - a method of measuring the activity of day hospitals. Age and ageing 1975. link 54 Bell A. Hospitals harbor hazards ignored in fight for life. The International journal of occupational health & safety 1975. link

    Original source

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      Knowledge, attitude and practices regarding pharmacovigilance among Turkish inpatients: A cross-sectional study. — Bekiroglu Ergun T, Akben M, Ergun Y, Altıntaş Aykan D Pakistan journal of pharmaceutical sciences (2026)
    2. [2]
      A model of the organizational resilience of hospitals in emergencies and disasters. — Seyghalani Talab F, Ahadinezhad B, Khosravizadeh O, Amerzadeh M BMC emergency medicine (2024)
    3. [3]
      Video-based automatic hand hygiene detection for operating rooms using 3D convolutional neural networks. — Kim M, Choi J, Jo JY, Kim WJ, Kim SH, Kim N Journal of clinical monitoring and computing (2024)
    4. [4]
      Who's on your team? Specialty identity and inter-physician conflict during admissions. — Schrepel C, Amick AE, Bann M, Watsjold B, Jauregui J, Ilgen JS et al. Medical education (2022)
    5. [5]
      Performance evaluation of general public hospitals in territories of the Former Yugoslavia: An ecological study using the Pabon Lasso model. — Medarević A The International journal of health planning and management (2022)
    6. [6]
      A Meta-Analysis on Evaluation of Nosocomial Infections Amongst Patients in a Tertiary Care Hospital. — Zhang B, Wu XL, Li R Journal of healthcare engineering (2021)
    7. [7]
      Nurses' awareness on hospital acquired infection risks of the geriatric patients: A descriptive and cross-sectional study. — Abumettleq ISS, Bayraktar N Journal of infection in developing countries (2021)
    8. [8]
      High proportion of multidrug-resistant organisms in children hospitalized abroad. — Uda K, Funaki T, Shoji K, Kato A, Miyairi I American journal of infection control (2020)
    9. [9]
      Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional Radiology: Detection Through Whole-genome Sequencing-based Surveillance. — Sundermann AJ, Babiker A, Marsh JW, Shutt KA, Mustapha MM, Pasculle AW et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2020)
    10. [10]
      The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the  time spent in hospital by older acute hospital inpatients. — Magill N, White IR, Walker J, Burke K, Toynbee M, van Niekerk M et al. Trials (2020)
    11. [11]
      Patients' and providers' perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge. — Uitvlugt EB, Janssen MJA, Siegert CEH, Leenders AJA, van den Bemt BJF, van den Bemt PMLA et al. Health expectations : an international journal of public participation in health care and health policy (2020)
    12. [12]
      Hospital Responses to Mortality Measures: A Survey of Hospital Administrative Leaders. — Soelch LA, Repp AB Quality management in health care (2019)
    13. [13]
      Establishing a Clinical Laboratory in a Tertiary/Quaternary Care Greenfield Hospital in the Middle East: Recounting the Cleveland Clinic Abu Dhabi Experience. — Mirza I, AbdelWareth LO, Liaqat M, Anderson P, Palmer B, Turner A et al. Archives of pathology & laboratory medicine (2018)
    14. [14]
      An Electronic Health Record Tool Designed to Improve Pediatric Hospital Discharge has Low Predictive Utility for Readmissions. — Brittan MS, Martin S, Anderson L, Moss A, Torok MR Journal of hospital medicine (2018)
    15. [15]
      The American College of Surgeons, Minimum Standards for Hospitals, and the Provision of High-Quality Laboratory Services. — Wright JR Archives of pathology & laboratory medicine (2017)
    16. [16]
      Professional responses to post bureaucratic hospital reforms and their impact on care provision. — Johnsen H Women and birth : journal of the Australian College of Midwives (2015)
    17. [17]
      Medical Physics: Forming and testing solutions to clinical problems. — Tsapaki V, Bayford R Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) (2015)
    18. [18]
      Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes. — Zadeh R, Sadatsafavi H, Xue R HERD (2015)
    19. [19]
      Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. — Wakabayashi H, Sashika H Journal of rehabilitation medicine (2014)
    20. [20]
      Optimization of decision support tool using medication regimens to assess rehospitalization risks. — Olson CH, Dierich M, Adam T, Westra BL Applied clinical informatics (2014)
    21. [21]
      Exploring in-hospital adverse drug events using ICD-10 codes. — Parikh S, Christensen D, Stuchbery P, Peterson J, Hutchinson A, Jackson T Australian health review : a publication of the Australian Hospital Association (2014)
    22. [22]
      Particle counting and microbiological air sampling: results of the simultaneous use of both procedures in different types of hospital rooms. — Armadans-Gil L, Rodríguez-Garrido V, Campins-Martí M, Gil-Cuesta J, Vaqué-Rafart J Enfermedades infecciosas y microbiologia clinica (2013)
    23. [23]
      Comparison of traditional trigger tool to data warehouse based screening for identifying hospital adverse events. — O'Leary KJ, Devisetty VK, Patel AR, Malkenson D, Sama P, Thompson WK et al. BMJ quality & safety (2013)
    24. [24]
      Equal efficacy of glucoprotamin and an aldehyde product for environmental disinfection in a hematologic transplant unit: a prospective crossover trial. — Meinke R, Meyer B, Frei R, Passweg J, Widmer AF Infection control and hospital epidemiology (2012)
    25. [25]
      Hospital acquired infections among surgical, gynaecology and obstetrics patients in Felege-Hiwot referral hospital, Bahir Dar, northwest Ethiopia. — Melaku S, Gebre-Selassie S, Damtie M, Alamrew K Ethiopian medical journal (2012)
    26. [26]
      Teach-back program reduces readmissions. Healthcare benchmarks and quality improvement (2011)
    27. [27]
      Calculating the frequency of serious reportable adverse events and hospital-acquired conditions. — Bunting RF Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management (2010)
    28. [28]
      Fast forward rounds: an effective method for teaching medical students to transition patients safely across care settings. — Ouchida K, LoFaso VM, Capello CF, Ramsaroop S, Reid MC Journal of the American Geriatrics Society (2009)
    29. [29]
      The "zero risk" concept for hospital-acquired infections: a risky business! — Carlet J, Fabry J, Amalberti R, Degos L Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2009)
    30. [30]
      Disclosure of hospital adverse events and its association with patients' ratings of the quality of care. — López L, Weissman JS, Schneider EC, Weingart SN, Cohen AP, Epstein AM Archives of internal medicine (2009)
    31. [31]
      Circumstances of death in hospitalized patients and nurses' perceptions: French multicenter Mort-a-l'Hôpital survey. — Ferrand E, Jabre P, Vincent-Genod C, Aubry R, Badet M, Badia P et al. Archives of internal medicine (2008)
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      In defence of the hospital standardized mortality ratio. — Jarman B HealthcarePapers (2008)
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      Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. — Sari AB, Sheldon TA, Cracknell A, Turnbull A, Dobson Y, Grant C et al. Quality & safety in health care (2007)
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      Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place. — Olsen S, Neale G, Schwab K, Psaila B, Patel T, Chapman EJ et al. Quality & safety in health care (2007)
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      Microbiological surveillance in the intensive care unit: a tertiary hospital experience. — Akcam FZ, Karaaslan D, Dogan M, Yayli G Medical science monitor : international medical journal of experimental and clinical research (2006)
    36. [36]
      Preparing for the Diploma in Immediate Medical Care of the Royal College of Surgeons of Edinburgh. — Le Clerc S Accident and emergency nursing (2005)
    37. [37]
      Antimicrobial resistance among Gram-negative bacteria isolated from intensive care units in a Cardiology Institute in Istanbul, Turkey. — Kucukates E Japanese journal of infectious diseases (2005)
    38. [38]
      Commentary: applying hospital quality indicators to clinical practice. — Fisher C, Fiorilli MG American journal of medical quality : the official journal of the American College of Medical Quality (2001)
    39. [39]
      The collision of healthcare and corporate law in a hospital closure case. — Himes SM Journal of health law (2001)
    40. [40]
      Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals. — Bond CA, Raehl CL, Franke T Pharmacotherapy (2000)
    41. [41]
      The hospitalist movement: ten issues to consider. — Wachter RM Hospital practice (1995) (1999)
    42. [42]
      Carrier rate of resistant enterococci in a tertiary care hospital in Norway. — Torfoss D, Aukrust P, Brinch L, Mathiesen O, Simonsen GS, Axelsen AK et al. APMIS : acta pathologica, microbiologica, et immunologica Scandinavica (1999)
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      Nosocomial infections in hand surgery. — Calkins ER Hand clinics (1998)
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      Focused factories. Are you ready for the competition? — Meyer H Hospitals & health networks (1998)
    45. [45]
      They're the best at keeping a lid on costs. — Lutz S Modern healthcare (1995)
    46. [46]
      Do transition grants help rural hospitals? — Wooldridge J, Cheh V, Thompson R, Moreno L, Holden N Health care financing review (1995)
    47. [47]
      The Yale Cost Model and cost centres: servant or master? — Rigby E Australian health review : a publication of the Australian Hospital Association (1993)
    48. [48]
      Audibility and identification of auditory alarms in the operating room and intensive care unit. — Momtahan K, Hétu R, Tansley B Ergonomics (1993)
    49. [49]
      Role statement: one hospital's experience. — O'Connell P Healthcare management forum (1991)
    50. [50]
      Hazards of hospital bulk oxygen delivery systems. — Bancroft ML, du Moulin GC, Hedley-Whyte J Anesthesiology (1980)
    51. [51]
      The urometer as a reservoir of infectious organisms. — Kocka FE, Roemisch E, Causey WA, O'Dell A American journal of clinical pathology (1977)
    52. [52]
      Development of hospital levels of care criteria. — Holloway DC, Holton JP, Goldberg GA, Restuccia JD Health care management review (1976)
    53. [53]
      The New Patient Index - a method of measuring the activity of day hospitals. — Martin A, Millard PH Age and ageing (1975)
    54. [54]
      Hospitals harbor hazards ignored in fight for life. — Bell A The International journal of occupational health & safety (1975)
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