Abstract 11192: Correlation of the Predictive Ability of Early Warning Metrics and Mortality for Cardiac Arrest Patients Receiving in-Hospital Cardiopulmonary Resuscitation

Abstract

Introduction: The Modified Early Warning System (MEWS) is a tool to help monitor patients and improve how quickly a patient experiencing a sudden decline in clinical status receives clinical care. Hypothesis/Aims: We assessed the risk factors that may be associated with hospital survival following cardiopulmonary resuscitation (CPR) in response to cardiac arrest (CA). In this study, we also examined the role of Modified Early Warning Score (MEWS) implementation on patients’ survival. Methods: Retrospective chart review of all patients who were treated with CPR after experiencing in-hospital CA (n=417) was conducted between January 2007 and December 2013, at a tertiary care hospital in the New York metropolitan area. The investigators determined survival rate for these patients and evaluated their MEWS on admission and during the 4 hours preceding the CA. Multivariable logistic regression was used to adjust for possible confounding factors. Specifically, we analyzed the relationship between MEWS and risk factors such as age, gender, type of electrographic cardiac rhythms, return of spontaneous circulation (ROSC) and MEWS using logistic regression. Results: Only 60% of the patient charts reviewed (256/417), indicated a return of spontaneous circulation (ROSC) following CPR. The overall survival rate, defined as survival to hospital discharge, was 21%. Strong predictors for survival were ventricular fibrillation (VF) (p<.0001) and ventricular tachycardia (VT) rhythm (p<.0001). MEWS values at hospital admission (p<.005) and patients of younger age (p<.005) were also significantly associated with survival to hospital discharge. In contrast, gender and MEWS prior to CA were not significantly associated with survival. Conclusions: Survival following CPR in response to in-hospital cardiac arrest is significantly associated with VF and VT rhythms and age. Moreover, MEWS at admission was significantly associated with survival, suggesting that higher MEWS scores at admission may be an important predictor of survival. MEWS monitoring may be an effective tool in identifying significant changes in a patient’s vital signs prior CA.