Critical illness related cardiac arrest (CIRCA)
Research type
Research Study
Full title
Critical illness related cardiac arrest (CIRCA): an investigation of the incidence and outcome of cardiac arrest within Intensive Care Units in the United Kingdom.
IRAS ID
260317
Contact name
Matt Thomas
Contact email
Sponsor organisation
Intensive Care National Audit & Research Centre (ICNARC)
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Cardiac arrest - where the heart stops - is an emergency. Resuscitation teams are called for specialist treatments. A national audit (the National Cardiac Arrest Audit - NCAA) monitors how often this happens in hospital. It does not include Intensive Care Units (ICUs).
Intensive Care Units look after the sickest patients in the hospital. They provide the resuscitation teams that go to cardiac arrests. If a patient already in ICU has a cardiac arrest the team is there anyway. No call is made. NCAA does not monitor these cardiac arrests.
The national audit for intensive care is called the Case Mix Programme (CMP). All patients admitted to ICU are included. It has information on cardiac arrest in the day before admission. The CMP does not monitor cardiac arrest after admission.
That means we do not know how often patients in an ICU have a cardiac arrest. We do not know what effect this has on them and their families. We do not know if it is possible to predict or to prevent these cardiac arrests.
All Intensive Care Units that take part in the Case Mix Programme and the National Cardiac Arrest Audit will be given a chance to take part. We will identify every cardiac arrest that happens in these ICUs for a year.
We will link information already held in the CMP, NCAA and Office for National Statistics. This will tell us what happens to patients after a cardiac arrest in the ICU. It will also help to identify risk factors. This will provide ways to improve the care given to patients.
Patients who survive to get home, and their families, will be invited to tell us how they are feeling 3, 6 and 12 months later. This will give information on the impact of critical illness related cardiac arrest.
Summary of study results:
Cardiac arrest happening in hospital is usually considered different to cardiac arrest out of hospital. This is because the precipitating event and immediate treatments are very different. This might also be true in a hospital when you compare the general wards to the Intensive Care Unit (ICU). Patients in ICU are very sick, but there is closer monitoring and more staff available to respond to problems. But we don't know how big the problem might be in ICU because many hospitals don't collect data for these patients if they have a cardiac arrest.
We did a one year prospective study to find out how common cardiac arrest in ICU actually is in adults in the United Kingdom. We also wanted to look at risk factors for the arrest occurring and influences on the chance of survival.In more than 50,000 patients recruited from 93 general adult ICUs we recorded 726 patients having a cardiac arrest. This is ten times more common than on the general hospital ward. Of these 35.4 % and 29.6 % survived to ICU and hospital discharge and 18.7 % survived to 12 months. Patients who were male or of non-white ethnicity were more likely to have a cardiac arrest, as were those who had already a cardiac arrest before ICU admission and those who has acute hear tor lung illness. Patients who were older, had COVID-19 or needed longer resuscitation were less likely to survive to get out of hospital. Quality of life was reduced in survivors.
Our research was disrupted by the first and second waves of the COVID-19 pandemic. However it is still the best estimate of the scale of the problem and we have identified areas for further research that could improve outcomes for patients.
REC name
South Central - Berkshire Research Ethics Committee
REC reference
19/SC/0465
Date of REC Opinion
23 Sep 2019
REC opinion
Favourable Opinion