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In Reply: Dr Manfredini and colleagues raise the possibility that biological factors may in part contribute to the lower survival from in-hospital cardiac arrest that occurs during nights and weekends. The NRCPR database cannot determine true circadian variability in the occurrence of cardiac arrest. Because the number of patients in the hospital is constantly in flux, we do not have a stable denominator with which to calculate circadian rhythmicity. However, we did not identify a lower frequency of events that paralleled the decreased survival we demonstrated during nights and weekends.

We agree that there may be some biological differences among patients that make them less likely to survive an in-hospital arrest that occurs during nights and weekends. We were able to exclude numerous clinical variables as being responsible for our findings and focused on the potential for human factors to be a contributing factor because hospitals work differently on nights . . . [Full Text of this Article]

Mary Ann Peberdy, MD
mpeberdy@aol.com
Virginia Commonwealth University
Richmond, Virginia

Amy H. Praestgaard, MS
University of Pennsylvania
Philadelphia

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