In-hospital cardiac arrest and resuscitation outcomes: rationale for sudden cardiac death approach (original) (raw)
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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.
Resuscitation, 2003
The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an American Heart Association (AHA)-sponsored, prospective, multisite, observational study of in-hospital resuscitation. The NRCPR is currently the largest registry of its kind. The purpose of this article is to describe the NRCPR and to provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States. All adult ( ]/18 years of age) and pediatric ( B/18 years of age) patients, visitors, employees, and staff within a facility (including ambulatory care areas) who experience a resuscitation event are eligible for inclusion in the NRCPR database. Between January 1, 2000, and June 30, 2002, 14 720 cardiac arrests that met inclusion criteria occurred in adults at the 207 participating hospitals. An organized emergency team is available 24 h a day, 7 days a week in 86% of participating institutions. The three most common reasons for cardiac arrest in adults were (1) cardiac arrhythmia, (2) acute respiratory insufficiency, and (3) hypotension. Overall, 44% of adult in-hospital cardiac arrest victims had a return of spontaneous circulation (ROSC); 17% survived to hospital discharge. Despite the fact that a primary arrhythmia was one of the precipitating events in nearly one half of adult cardiac arrests, ventricular fibrillation (VF) was the initial pulseless rhythm in only 16% of inhospital cardiac arrest victims. ROSC occurred in 58% of VF cases, yielding a survival-to-hospital discharge rate of 34% in this subset of patients. An automated external defibrillator was used to provide initial defibrillation in only 1.4% of patients whose initial cardiac arrest rhythm was VF. Neurological outcome in discharged survivors was generally good. Eighty-six percent of patients with Cerebral Performance Category-1 (CPC-1) at the time of hospital admission had a postarrest CPC-1 at the time of hospital discharge. # Julho de 2002 ocorreram 14720 paragens cardíacas, em adultos, de 207 hospitais participantes que cumpriram critérios de inclusão. Em 86% das instituiçõ es participantes está disponível uma equipe de emergência organizada 24 horas por dia, 7 dias por semana. As 3 razõ es mais frequentes para paragem cardíaca nos adultos foram: (1) arritmia cardíaca, (2), insuficiência respirató ria aguda e (3) hipotensão. Globalmente, 44% dos adultos vítimas de paragem cardíaca intrahospitalar tiveram retorno da circulação espontânea (ROSC); 17% sobreviveram até alta hospitalar. Apesar do facto de uma arritmia primária ser um dos eventos precipitantes em cerca de metade das paragens cardíacas nos adultos, a fibrilhação ventricular (VF) foi o ritmo sem pulso inicial em apenas 16% das vítimas de paragem cardíaca intrahospitalar. Em 58% dos casos de VF ocorreu ROSC, resultando uma taxa de sobrevida até alta hospitalar de 34% neste subgrupo de doentes. Um desfibrilhador automático externo foi usado para administrar a desfibrilhação inicial em apenas 1,4% dos doentes em que o ritmo cardíaco inicial de paragem foi VF. O resultado neuroló gico nos sobreviventes com alta foi na generalidade bom. Oitenta e seis por cento dos doentes com Categoria de Performance Cerebral Á/1 (CPC-1) no momento da admissão hospitalar tiveram CPC-1 pó s-paragem no momento da alta hospitalar. #
Therapeutics and clinical risk management, 2018
There are limited data available regarding long-term survival and its predictors in cases of in-hospital cardiac arrest (IHCA) in which patients receive cardiopulmonary resuscitation. The objectives of this study were to determine the 1-year survival rates and predictors of survival after IHCA. Data were retrospectively collected on all adult patients who were administered cardiopulmonary resuscitation from January 1, 2013 to December 31, 2014 in Srinagarind Hospital (Thailand). Clinical outcomes of interest and survival at discharge and 1 year after hospitalization were reviewed. Descriptive statistics and survival analysis were used to analyze the outcomes. Of the 202 patients that were included, 48 (23.76%) were still alive at hospital discharge and 17 (about 8%) were still alive at 1 year post cardiac arrests. The 1-year survival rate for the cardiac arrest survivors post hospital discharge was 72.9%. Prearrest serum HCO<20 meq/L, asystole, urine <800 cc/d, postarrest coma...
Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest
Resuscitation, 2009
Although clinicians are expected to help patients make decisions about end-of-life care, there is insufficient data to help guide patient preferences. The objective of this study was to determine the frequency of patients who undergo ‘limited code’ and compare survival to discharge with those who undergo maximum resuscitative efforts (‘full code’).We performed a retrospective analysis of all adult in-hospital cardiac arrests (IHCA) at a tertiary care teaching hospital from January 1999 to December 2003 to compare survival in patients with limited code to survival in patients with a full code. We collected data on demographic and clinical variables known to influence survival in IHCA. Logistic regression was used to assess the association of code status with subsequent survival through the code and to hospital discharge after adjusting for potential confounding factors.Of the 309 patients having IHCA, there were 17 (5.5%) patients with limited code status and 292 (94.5%) with full code status. Among full code patients, 171 (58.6%) survived the code compared to five patients (29.4%) who had a limited code (p = 0.023). After adjusting for demographic variables and pre-arrest co-morbidities, patients with full code status compared to limited code status had an odds ratio for return of spontaneous circulation of 3.69 (95% CI: 1.13–14.34).Patients who opt for limited code have a significantly lower probability of survival compared to patients who choose full code. Patients who choose limited code should be informed of the likely negative outcome as compared to full resuscitation.
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 =...
Successful resuscitation of out of hospital cardiac arrest patients in the emergency department
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2011
Background. We examined factors associated with the successful resuscitation, in the emergency department (ED), of adult, out-of-hospital cardiac arrest (OHCA) patients. Methods. The study cohort consisted of adult patients (over 18 years of age) who presented to the ED in 2009 with a diagnosis of cardiac arrest. Data were retrieved from the institutional database. Results. A total of 122 adult, non-traumatic, OHCA patients were enrolled in the study. There were no significant differences between the sustained return of spontaneous circulation (ROSC) and non-sustained ROSC groups in initial body temperature (P = 0.420), time to successful intubation (P = 0.524), time to first intravenous epinephrine injection (P = 0.108), blood sugar levels (P = 0.122), hematocrit (P = 0.977), cardiac enzymes (P = 0.116) and serum sodium level (P = 0.429). Leukocytosis (P = 0.047) and cardiac rhythm of pulseless ventricular tachycardia/ ventricular fibrillation and pulseless electrical activity (P = 0.022), were significantly associated with sustained ROSC. In contrast, patients with more severe acidosis (P = 0.003) and hyperkalemia (P < 0.001) had a reduced likelihood of achieving sustained ROSC. After multiple variable logistic regression analysis adjusting for variables, the correlation between sustained ROSC and leukocytosis and hyperkalemia remained high (leukocytosis,
Unsuccessful resuscitation after cardiac arrest in the intensive care unit: single center analysis 1
complains out of the hospital, so we can assume that the cardiac arrest event they suffered was the result of an acute issue, and not of a prolonged suffering. Nevertheless, facts considered potential factors for a poor outcome in OHCA, such as early recognition of the medical emergency, bystander CPR, early advanced life support, are not an issue for patients admitted in the ICU. The ICU represents a special medical facility with medical personnel of high expertise, nursing care and complex life sustaining medical equipment. The patients admitted in the ICU are in severe condition; therefore it is not unexpected for cardiac arrest to occur. In the Intensive Care Unit (ICU) the patients are permanently monitored, and this fact lowers the possibility for an un-witnessed or unmonitored cardiac arrest to occur (Myrianthefs et al 2003). Nevertheless, the patients admitted in the ICU are already in poor condition, often with hemodynamic and/or respiratory impairment and the characteristi...