Survival From In-hospital Cardiac Arrest on the Internal Medicine Clinical Teaching Unit (original) (raw)
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Objective: To examine clinical variables and outcomes in patients with out-of-hospital (unwitnessed) and emergency department (ED; witnessed) cardiac arrests at a tertiary care hospital in Karachi. Methods: A prospective observational study was conducted to note that outcomes in patients with first attempted cardiopulmonary resuscitation in the Emergency Department of the Aga Khan University Hospital, Karachi, between Jan. 2000 and Dec. 2000. Cardiac arrest was defined as absence of a palpable central pulse and apnoea. Return of spontaneous circulation (ROSC) and survival at hospital discharge were primary outcomes. Logistic regression was applied to determine predictors for ROSC. Results: Of 106 patients with cardiac arrest, 59% (n=62/106) patients had ROSC [52% (n=29/56) of unwitnessed group; 64% (n=32/50) of witnessed group]. Mean age was 48 years (range: 27-86); 68% (n=72/106) were males; and 41% (n=43/106) had ventricular fibrillation (VF) as initial rhythm. Male gender (OR 0.381; CI 0.156-0.928), PEA (OR 0.175; CI 0.063-0.489, reference VF) and asystole (OR 0.328; CI 0.114-0.944, reference VF) were negatively associated with ROSC. Less than ten minutes duration of CPR (OR 63.628;) and one co-morbidity status (OR 3.607; CI: 1.26-10.327, reference two or more co-morbidities) were positively associated with ROSC. Overall, 22% (n=23/106) of enrolled patients left the hospital alive: 34% (n=17/50) of the witnessed group and 12% (n=6/56) of the unwitnessed group. Conclusion: Out of hospital arrest was associated with dismal survival at hospital discharge, emphasizing the need for development of pre-hospital care services for our country (JPMA 57:278;2007).
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%.
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, 2002
To determine the incidence of avoidable cardiac arrest among patients who had received resuscitation in a district general hospital. To establish how location and individual or system factors influence avoidable cardiac arrest in order to develop an evidence-based preventive strategy. Methods: Expert panel review of case-notes from 139 consecutive adult in-hospital cardiac arrests over 1 year. Results: There were 32 348 adult admissions in 1999 with 1023 deaths. The cardiac arrest team was activated 139 times: 118 were for primary in-hospital cardiac arrest. The cardiac arrest rate excluding 'do not attempt resuscitation' (DNAR) cases was 3.8/1000 admissions. In 88.5% of deaths there was a DNAR policy. Survival to hospital discharge following resuscitation was 14%. Among the 118 cases, the panel unanimously agreed that 61.9% of arrests were potentially avoidable, rising to 68% when emergency department arrests were excluded (66 and 73% for majority opinion). Cardiac arrests were more likely at the weekend than during the week (P0/0.02). The odds of potentially avoidable cardiac arrest was 5.1 times greater for patients in general wards than critical care areas (P B/0.001); patients in critical care areas were more likely to survive (P B/0.001). The odds of potentially avoidable cardiac arrest was 12.6 times greater for patients nursed in a clinical area judged 'inappropriate' for their main complaint (P B/0.002, Fisher's exact test) compared to those nursed in 'appropriate' areas. The panel agreed that 100% of potentially avoidable arrests were judged to have received inadequate prior treatment. Clinical signs of deterioration in the preceding 24 h were not acted upon in 48%, and review was confined to a house officer in 45%. Conclusion: The majority of treated in-hospital cardiac arrests are potentially avoidable. Multiple system failures include delays and errors in diagnosis, inadequate interpretation of investigations, incomplete treatment, inexperienced doctors and management in inappropriate clinical areas. #
Twenty Year Trends of Survival after In-Hospital Cardiac Arrest
2017
BACKGROUND In 2006, the Israeli Ministry of Health distributed guidelines for improving cardiopulmonary resuscitation (CPR) knowledge among hospital staff. The impact of these guidelines on survival after in-hospital cardiac arrest (IHCA) is unclear. OBJECTIVES To compare rates of incidence and survival to discharge after IHCA, preceding and subsequent to issuance of the guidelines: 1995-2005 and 2006-2015. METHODS Data were retrieved from the computerized records of patients who had an IHCA and underwent CPR. In addition, we retrieved data available from the hospital's resuscitation committee that included number, type, methods of training in CPR refresher courses, type and number of audits carried out during the past 10 years, and type of CPR quality assessments. RESULTS From 1995 to 2015, IHCA incidence increased from 0.7 to 1.7 per 1000 admissions (P < 0.001), while survival rate did not increase (P = 0.37). Survival for shockable rhythms increased from 15.4 to 30.2% (P =...
In-hospital cardiac arrest: can we change something?
Wiener klinische Wochenschrift, 2013
Cardiac arrest is classified as an 'in-hospital' if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient's survival until hospital discharge is very low. The reasons for this are old age, multiple comorbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams and poor organization.