Re-arrest immediately after return of spontaneous circulation: A retrospective observational study of in-hospital cardiac arrest

Eirik Unneland; Anders Norvik; Daniel Bergum; David G Buckler; Abhishek Bhardwaj; Trygve Christian Eftestøl; Elisabete Aramendi; Trond Nordseth; Benjamin S Abella; Jan Terje Kvaløy; Eirik Skogvoll

doi:10.1111/aas.14567

Re-arrest immediately after return of spontaneous circulation: A retrospective observational study of in-hospital cardiac arrest

Acta Anaesthesiol Scand. 2025 Jan;69(1):e14567. doi: 10.1111/aas.14567.

Authors

Eirik Unneland¹, Anders Norvik^{1

2}, Daniel Bergum², David G Buckler³, Abhishek Bhardwaj⁴, Trygve Christian Eftestøl⁵, Elisabete Aramendi⁶, Trond Nordseth^{1

2

7}, Benjamin S Abella⁸, Jan Terje Kvaløy⁹, Eirik Skogvoll^{1

2}

Affiliations

¹ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
² Department of Anesthesia and Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway.
³ Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Medicine, University of California, Riverside, California, USA.
⁵ Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway.
⁶ Engineering School of Bilbao, BioRes Group, University of the Basque Country, Bilbao, Spain.
⁷ Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.
⁸ Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁹ Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.

Abstract

Background: Patients who achieve return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA) may re-arrest. This phenomenon has not been sufficiently investigated. The aim of this study was to examine the immediate (1-min) and short-term (20-min) risks of re-arrest in IHCA.

Methods: We retrospectively analyzed four datasets of IHCA episodes, comprising defibrillator recordings collected between 2002 and 2022. Re-arrest was defined as the resumption of chest compressions following a period of ROSC after cardiac arrest of any duration. Parametric models were applied to calculate the immediate risk of re-arrest. In addition, we estimated the short-term risk of re-arrest within 20 min.

Results: In 763 episodes of IHCA, we observed 316 re-arrests: 68% to pulseless electrical activity (PEA), 25% to ventricular fibrillation/ventricular tachycardia (VF/VT), and 7% to asystole. Most re-arrests occurred with the same rhythm as in the initial arrest. When ROSC was achieved from a non-shockable rhythm, the risk of re-arrest to a non-shockable rhythm was initially 2% per minute and decreased to 1% per minute after 9 min. The corresponding risk of re-arrest to VF/VT was constant at 2% per minute. If ROSC was obtained from a shockable rhythm, the risk of re-arrest to a shockable rhythm was initially 5% per minute, decreasing to 4% per minute after 9 min. The corresponding risk to a non-shockable rhythm was constant at 1% per minute. The risk of re-arrest within 20 min was 27%, and the overall risk of at least one re-arrest per episode was 33%.

Conclusions: The immediate risk of re-arrest was approximately 2% per minute, with the highest risk occurring as a reversion to VF/VT if ROSC was obtained from VF/VT. The risk of re-arrest within 20 min of the initial arrest was 27%, and the overall risk of at least one re-arrest per episode was 33%.

Keywords: IHCA; ROSC; cardiac arrest; parametric models; re‐arrest.

Publication types

Observational Study

MeSH terms

Aged
Cardiopulmonary Resuscitation / methods
Female
Heart Arrest* / therapy
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Return of Spontaneous Circulation*

Abstract

Publication types

MeSH terms

Grants and funding