Outcomes of In-hospital Cardiac Arrest: Insights from a Medical Intensive Care Unit
Karthik Kailasam, Mahmoud Alwakeel, Xiaofeng Wang, Abhijit Duggal, Sudhir Krishnan
Abstract
Critically ill patients admitted to intensive care units (ICU) usually suffer from life-threatening illnesses, and many are hemodynamically unstable. The incidence of cardiac arrest in the ICU is approximately 22 per 1000 admissions, and survival to discharge after in-hospital cardiac arrest (IHCA) is approximately 14%.
Introduction
There are approximately 292,000 in-hospital cardiac arrests (IHCA) in the United States every year, with one in four survivors [1]. The factors associated with survival and favorable neurological outcomes following IHCA are poorly understood. Girotra et al showed improvements in IHCA survival to discharge from 13.7% in 2000, up to 22.3% in 2009.
Materials and methods
We conducted an institutional review board-approved, single-center, 5-year retrospective study of all critically ill patients > 18 years of age (N = 367) who had an in-hospital cardiac arrest (January 2014 to December 2018). Patients were admitted to the 64-bed adult medical intensive care unit at the Cleveland Clinic.
Results
The baseline characteristics of our study population and characteristics of IHCA based on the duration of resuscitation are noted in Table 1 and Table 2 respectively. The mean age was 61 years (IQR, 51–73) of which 55% were men.
Discussion
In our study, we report ICU-IHCA survival of 16.3% at hospital discharge in comparison to previously reported 14% survival to discharge after IHCA in ICU patients over the years 2003–2010 [6]. Improved survival rate in our study population is likely related to continued advancements in resuscitation methods and clinical care over the last decade [8,9].
Conclusion
Based on our study findings, the mortality after IHCA increases with the increase in the duration of CPR regardless of age, initial rhythm, and severity of underlying illness. Further studies using clinical decision rules like GO-FAR score might assist the healthcare team in selecting appropriate patients who might benefit from prolonged resuscitation.
Citation: Kailasam K, Alwakeel M, Wang X, Duggal A, Krishnan S (2026) Outcomes of In-hospital Cardiac Arrest: Insights from a Medical Intensive Care Unit. PLoS One 21(6): e0340658. https://doi.org/10.1371/journal.pone.0340658
Editor: Martin Kieninger, Universitatsklinikum Regensburg, GERMANY
Received: April 22, 2026; Accepted: May 30, 2026; Published: June 22, 2026
Copyright: © 2026 Kailasam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data for this study is available at Kailasam, K. (2026). IHCA data [Data set]. Zenodo. https://doi.org/10.5281/zenodo.20578205.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
