Commentary: Kause J et al. (2004). A comparison of antecedents to cardiac arrest, deaths and emergency intensive care admissions in Australia and ANZ, and the UK – the ACADEMIA study (original) (raw)
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2008
Objective: Despite advances in medicine, adverse clinical events, especially cardio-respiratory arrests, still occur in hospitalized patients. Unplanned Intensive Care Unit (ICU) admissions are frequently a result of this failure to recognize or appropriately treat the ‘pre-arrest’ period, when signs of physiologic deterioration are often evident. Although survival rates to hospital discharge for cardiac arrests are universally poor, the patterns of clinical deterioration and outcome of unplanned medical ICU admissions is not well studied.
Emergency medicine international, 2014
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Antecedents to cardiac arrests in a teaching hospital intensive care unit
Resuscitation, 2014
Background: In hospital cardiac arrests (CA) treated with cardio-pulmonary resuscitation (CPR) outside of the intensive care unit (ICU) have poor outcomes. Most are preceded by deranged vital signs. There are, however, limited studies assessing antecedents to CAs inside the ICU. Objectives: To study the antecedents to, and characteristics of CAs in ICU. Study population: We prospectively identified CA cases that occurred inside our ICU between January 2010 and July 2012. Controls were obtained by sequentially matching ICU patients based on APACHE III diagnosis, APACHE III score, age, gender and length of stay in ICU. Results: Thirty-six patients had a CA during the study period (6.28/1000 admissions). In the 12 h prior to CA, index patients had higher maximum (22 breaths/min vs. 18 breaths/min, p = 0.001) and minimum respiratory rates (16 breaths/min vs. 12 breaths/min, p = 0.031), a lower median mean arterial pressure (65 mmHg vs. 70 mmHg, p = 0.029) and systolic blood pressure (97 mmHg vs. 106 mmHg, p = 0.033), a higher central venous pressure (14 cm H 2 O vs. 11 cm H 2 O, p = 0.008) and a lower bicarbonate level (20.5 mmol vs. 26 mmol, p = 0.018) compared to controls. CA patients also had a higher maximum dose of noradrenaline (norepinephrine) (17.5 mcg/min vs. 8.0 mcg/min, p = 0.052) but there was no difference in any other levels of intensive care support. Two-thirds of CA's occurred within the first 48 h of ICU admission. The initial monitored rhythm was non-shock responsive (pulseless electrical activity, bradycardia or asystole) in 26/36 (72%). Return of spontaneous circulation was achieved in 29/36 (80.6%) patients, with 16/36 (44.4%) surviving to hospital discharge. Conclusions: In the period leading up to the CA inside ICU, there were signs of physiological instability and the need for higher doses of noradrenaline. Return of spontaneous circulation was achieved in 80%. However, in-hospital mortality was greater than 50%.
Circulation. Cardiovascular quality and outcomes, 2015
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Antecedents to cardiac arrests in a hospital equipped with a medical emergency team
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2011
Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. To determine what proportion of patients who had cardiac arrests had documented MET criteria before the arrest, and what proportion had a premorbid status suggesting they were unsuitable resuscitation candidates. Prospective observational study of cardiac arrests at the Austin Hospital, Melbourne, Australia, 1 April - 30 September 2010. Data were obtained from the patients' records and electronic "respond blue" database. Patients' premorbid medical condition and functional status; prior "not-for-resuscitation" (NFR) order; presence or absence of a MET call before cardiac...
Critical Care Medicine, 2010
To determine the long-term impact of a medical emergency team on survival and to assess the utility of administrative data to monitor outcomes. Design: Prospective study of cardiac arrests and survival. Retrospective study of administrative data. Setting: University affiliated tertiary referral hospital in Melbourne, Australia. Patients: All patients admitted to hospital in three 6-month periods between 2002-2007 (prospective) and 1993-2007 (retrospective). Intervention: Implementation of a medical emergency team in November 2002. Measurements and Main Results: In the prospective analysis, rates of unexpected cardiac arrest and hospital mortality (referenced to 1000 patient-care days) were measured before (
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2012
Background: Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
Journal of Critical Care, 2018
Little is known about long-term survival after In-Hospital Cardiac Arrest (IHCA). The purpose of this study is to report the one-year survival of patients after IHCA and to identify predicting factors. Methods: Single-center retrospective study of all adult in-hospital CPR attempts conducted between 2003 and 2014 in a tertiary teaching hospital. Demographic and clinical variables of patients were obtained at 24 h pre-arrest, during CPR and post-CPR. All patients were tracked one year after discharge from hospital. Results: CPR was performed for IHCA on 417 patients. Return of spontaneous circulation (ROSC) was achieved in 283 (68%) patients, 234 were admitted to ICU. Overall, 95 (23%) patients survived one year after discharge, The survival rate of patients who were admitted to ICU after IHCA was 38% (89/234) at hospital discharge and 26% (61/234) at one year. Univariate analysis showed numerous variables are associated with one-year survival, for example comorbidity index and time to ROSC. Discussion: One-year survival of patients admitted to the ICU after IHCA was 26%. Severity of disease pre-arrest and at ICU-admission could prove useful in prognostication. No multivariate model could be constructed and large prospective studies are needed to elicit the role of pre-arrest factors on survival.
Resuscitation, 2004
Background: Patients with unexpected in-hospital cardiac arrest often have an abnormal clinical observation prior to the arrest. Previous studies have suggested that a medical emergency team responding to such patients may decrease in-hospital mortality from cardiac arrest, but the association between any abnormal clinical observation and subsequent increased mortality has not been studied prospectively. The aim of this study was to determine the predictive value of selected abnormal clinical observations in a ward population for subsequent in-hospital mortality. Design and setting: Prospective data collection in five general hospital ward areas at Dandenong Hospital, Victoria, Australia. Interventions: None. Results: During the study period, 6303 patients were admitted to the study areas. Of those, 564 (8.9%) experienced 1598 pre-determined clinically abnormal events and 146 of these patients (26%) died. The two commonest abnormal clinical events were arterial oxygen desaturation (51% of all events), and hypotension (17.3% of all events). Using a multiple linear logistic regression model, there were six clinical observations which were significant predictors of mortality. These were: a decrease in Glasgow Coma Score by two points, onset of coma, hypotension (<90 mmHg), respiratory rate <6 min −1 , oxygen saturation <90%, and bradycardia >30 min −1 . The presence of any one of the six events was associated with a 6.8-fold (95% CI: 2.7-17.1) increase in the risk of mortality. Conclusions: Six abnormal clinical observations are associated with a high risk of mortality for in-hospital patients. These observations should be included as criteria for the early identification of patients at higher risk of unexpected in-hospital cardiac arrest.