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Background— A growing number of hospitals have begun to implement policies allowing for family presence during resuscitation (FPDR). However, the overall safety of these policies and their effect on resuscitation care is unknown. Methods and Results— We conducted an observational cohort study of 252 hospitals in the United States with 41 568 adults with cardiac arrest. Multivariable hierarchical regression models were used to evaluate patterns of care at hospitals with and without an FPDR policy. Primary outcomes included return of spontaneous circulation and survival to discharge. Secondary outcomes included resuscitation quality, interventions, and facility-reported potential resuscitation systems errors. There were no significant differences in facility characteristics between hospitals with and without an FPDR policy, nor were there significant differences in return of spontaneous circulation (adjusted risk ratio, 1.02; 95% confidence interval, 0.95–1.06) or survival to discharge (adjusted risk ratio, 1.05; 95% confidence interval, 0.95–1.15). There was a small, borderline significant decrease in the mean time to defibrillation at hospitals with an FPDR policy compared with hospitals without the policy (mean difference, 0.32 minutes; 95% confidence interval, −0.01 to 0.64). Resuscitation quality, interventions, and facility-reported potential resuscitation systems errors did not meaningfully differ between hospitals with and without an FPDR policy. Conclusions— Hospitals with an FPDR policy generally have no statistically significant differences in outcomes and processes of care as hospitals without this policy, suggesting such policies may not negatively affect resuscitation care. Further study is warranted about the direct effect of FPDR attempts on adult patients with an in-hospital cardiac arrest and their families.

Background: Data on longitudinal shifts in diagnoses, co-morbidities, illness severity and procedure use among patients admitted to the cardiac intensive care unit (CICU) are limited. Improving our understanding of the evolving case-mix of these critically ill patients has important implications. Methods: We performed a retrospective cohort study of hospitalized, elderly (age ≥ 65 years), fee-for-service Medicare beneficiaries using Medicare Provider Analysis and Review files from 2000-2010. Analysis was limited to patients billed for a CICU stay. Using the Clinical Classification Software from the Agency for Health Care Research and Quality, we collapsed primary ICD-9-CM admission diagnosis codes into broad disease categories. We assessed for changes in patient demographics, primary admission diagnosis, co-morbidities (Elixhauser), organ failure, procedure use, and outcomes. Time trends were assessed using Poisson regression. Comparisons between patients in 2000 and 2010 were performed using chi-squared analysis. Results: Among 5.4 million CICU admissions from 2000-2010, the primary admission diagnosis changed substantially, with non-cardiac diagnoses becoming more prevalent (Table). Primary admission diagnoses of coronary artery disease (CAD) and congestive heart failure (CHF) decreased from 32.7% to 9.9% and 9.6% to 7.7%, respectively. In contrast, infectious diseases increased from 7.6% to 13.5% and respiratory diseases increased from 6.1% to 7.8% (p for trend < 0.001 for all). An increase in the percentage of patients with cardiovascular co-morbidities including CHF (11.9% to 28.7%), pulmonary vascular disease (1.2% to 5.1%), valvular disease (4.2% to 9.1%), and ≥1 organ failure (20.9% to 38.1%) was noted. Also, hemodialysis rates (2.7% to 4.2%), non-invasive ventilation rates (0.6% to 3.5%), and central venous catheter use (5.5% to 12.7%) increased, while pulmonary artery catheter use decreased (2.1% to 0.9%). Crude in-hospital mortality rate decreased from 9.4% to 8.3%. Conclusions: Case-mix of CICU admissions has shifted over the last decade, with a significant decrease in primary admission cardiac diagnoses but rising cardiovascular co-morbidities. The CICU has become a setting where patients with advanced cardiac conditions are treated for a wide variety of acute illnesses.

Background: The intensive care unit (ICU) has been credited with reducing mortality for patients hospitalized with AMI in a past era when life-threatening post-infarction ventricular arrhythmias were more common. With the evolution in the clinical profile and treatment of AMI, the marginal benefit of ICU care for many patients is less clear. As a result, the use of ICU care for patients with AMI may vary substantially among institutions, creating implications for treatment strategies and patient outcomes. Methods: We identified 114,980 hospitalizations for AMI from 311 hospitals in the 2009-10 Premier database using ICD-9-CM codes. We excluded hospitals with Results: ICU admission rates for AMI patients varied markedly among hospitals (median 48%, IQR 35%-61%, range 0%-98%, Figure). Hospitals admitting more AMI patients to the ICU (higher quartiles) were (1) more likely to use critical care therapies in AMI patients overall (mechanical ventilation [Q1 to Q4: 13% to 16%], vasopressors/inotropes [17% to 21%], intra-aortic balloon pumps [4% to 7%], and pulmonary artery catheters [4% to 5%]; p for trend Conclusion: ICU admission rates for AMI vary substantially across hospitals with evidence of greater use of ICU therapies in high admitting hospitals but without evidence of lower overall mortality. There is a need for further research to determine the optimal use of ICU care for contemporary populations of patients with AMI.