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"The NCAA team works tirelessly with hospitals to ensure that data is provided in a timely and accurate manner. This information then provides cumulative analysis reports each quarter to support local performance management and quality improvement."
Source: ICNARC
At the end of March, the Intensive Care National Audit & Research Centre (ICNARC) published its National Cardiac Arrest Audit (NCAA) for 2022-2023. The audit, supported by Resuscitation Council UK (RCUK), was first launched in 2009 and is a clinical audit of in-hospital cardiac arrests in the UK.
Here, we’ll explore some key takeaways from the NCAA, looking into which hospitals participated, the rates of cardiac arrests, which patients are most vulnerable, and an assessment of outcomes.
Please note: All information presented in this summary of the NCAA is taken directly from the report itself. You can read the report in full by visiting the ICNARC website.
The Aim of the NCAA
The mission of the NCAA can be clearly broken down into four key aims:
- To improve patient outcomes after in-hospital cardiac arrest.
- To decrease the incidence of avoidable cardiac arrest.
- To decrease incidence of inappropriate resuscitation.
- To promote adoption and compliance with evidence-based practice.
How is the research conducted?
The ICNARC invites participant hospitals to submit data for “any resuscitation event, commencing in-hospital, where an individual (excluding neonates) receives chest compression(s) and/or defibrillation and is attended by the hospital-based resuscitation team (or equivalent) in response to a 2222 call.”
As some readers will be aware, 2222 is a standardised internal phone number used in European hospitals to call for help during a cardiac arrest. For brevity, such responses are referred to as ‘team visits.’
The NCAA team works tirelessly with hospitals to ensure that data is provided in a timely and accurate manner. This information then provides cumulative analysis reports each quarter to support local performance management and quality improvement.
Which Hospitals Participated?
Throughout the course of the NCAA, a total of 184 hospitals participated. Of these, the vast majority (175) were acute general hospitals, while the remaining 9 were made up of specialist cardiothoracic (6) and cancer (3).
The participant hospitals predominantly represented communities across England, with only 4 Scottish hospitals taking part. These encompassed trusts from Cumbria to the south coast and from Cornwall to East Anglia.
Source: ICNARC
The Rates of Cardiac Arrests in Hospitals
One of the most important takeaways from the NCAA is its analysis of the occurrences of cardiac arrests in hospitals.
The overall rate of in-hospital cardiac arrests was 1.03 per 1,000 admissions, which is an increase from the previous year. However, the audit has appeared to display a downward trend nationwide since January 2024.
What is the breakdown by location?
Of the participant hospitals, Scotland saw the highest rate of cardiac arrest at 1.37 per 1,000 admissions, though admittedly from a small sample size. The next highest was the South East of England, with 1.13 per 1,000.
The region with the lowest instance of cardiac arrest was the North West, where 1,179 team visits were recorded for 1,598,334 admissions – a rate of 0.74 per 1,000.
Which Patients Were at the Greatest Risk?
Data summary from the NCAA shows that the mean age for patients experiencing cardiac arrest was around 69 years old. This is largely due to a spike in occurrences in the demographic of 75-84, which saw over 30% of all cardiac arrests.
Further evidence shows that patients aged 65+ were at significantly higher risk, accounting for almost 70% of all recorded in-hospital cardiac arrests.
Source: ICNARC
Are there trends in patient characteristics?
Overall, patient characteristics remained relatively consistent throughout 2022-2023. In general, men are still more at risk from cardiac arrest than women, accounting for around 63% of all in-hospital arrests. Similarly, age demographics have maintained consistent stability throughout the year.
Cardiac Arrest Characteristics
When do in-hospital cardiac arrests occur?
The NCAA summary shows that almost half (46.1%) of cardiac arrests occur within a day of admission to hospital, while a further 31% of arrests take place during the first week.
Despite this, only 1 in 5 (19.6%) cardiac arrests took place during presentation at hospital, while the remainder took place at an in-hospital location, treatment area, or during critical/coronary care.
Patient status on the arrival of teams at a cardiac arrest.
The overwhelming majority (99.1%) of cardiac arrests were attended by teams before the patient died. For most of these cases (80.3%), resuscitation was already ongoing. Fewer than 1% of patients died from a cardiac arrest before a team could arrive.
Measuring In-Hospital Cardiac Arrest Outcomes
Overall, outcomes showed that 50.4% of resuscitation outcomes were successful, with patients surviving the resuscitation process. Among patients who received successful resuscitation, 23.0% survived hospital discharge.
When comparing acute general hospital outcomes, this survival rate is mirrored almost identically, with a resuscitation survival rate of 49.4% and a discharge survival rate of 21.8%.
However, in specialist cardiothoracic hospitals, the data summary from the NCAA shows considerably higher successful resuscitation outcomes. 71.1% survived resuscitation, while 47.4% of patients survived hospital discharge.
Source: ICNARC
Shockable vs Non-Shockable Patients
Among cardiac arrests that can be treated with defibrillation, overall survival to discharge was more than double the average (49.9%). However, among non-shockable (PEA and Asystole) cardiac arrests, 15.3% and 8.6% of patients survived hospital discharge. These latter categories accounted for 70.1% of all team visits.
What is the trend?
The NCAA data represents a consistency in survival rates. In 2021-2022, 22.7% of patients survived hospital discharge, compared to 23.0% in 2022-2023. This stability was similarly replicated among both shockable and non-shockable patient groups.
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