Abstract
Objective: Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low. The use of initial documented cardiac rhythm as predictor of Survival-to-discharge is still unclear. This study aimed to assess whether the initial documented rhythm can be used as a predictor of survival-to-discharge following IHCA in an emergency department of the tertiary care referral institute, south India. Methods: This observational study was conducted for six months from January to June 2017 among all patients above 12 years, with witnessed cardiac arrest after arrival at the emergency department. After obtaining informed consent from the patients’ caregivers, data of socio-demographic details, previous relevant medical history, initial documented rhythm, neurologic status and survival-to-discharge were collected and analyzed. Results: The mean age of participants was 50 ± 17.15 years. Of the 252 study participants, 77.4% had non-shockable and 22.6% had shockable rhythm as initial documented rhythm. The overall survival-to-discharge rate was 17.5% (n=44) in our study. The overall proportion of participants who survived to discharge after IHCA was higher among participants with shockable rhythm (16/57, 28%) in comparison to participants with non-shockable rhythm (28/195, 14.3%). These differences were found to be statistically significant. Among the patients with shockable rhythm, 61.1% had good cerebral performance. Conclusion: Survival-to-discharge rates after IHCA can be predicted based on the initial documented cardiac rhythm. Early identification of patients with impending cardiac arrest and providing prompt management of patients with cardiac arrest will improve the survival rates significantly.
Highlights
Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low [1]
The initial documented rhythms were classified as Ventricular fibrillation (VF), pulseless ventricular tachycardia (VT(p)), pulseless electrical activity (PEA), and asystole
VT (P) (33.3%) had better survival compared to VF (23.3%) Among patients with non-shockable rhythm, 136 (136/195, 69.7%) had PEA and 59 (59/195, 30.2%) had asystole as
Summary
Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low [1]. The initial documented rhythm, quality of the resuscitation, intervals between multiple arrests, and duration of events are some of the intra-arrest factors that will influence the survival outcomes. Among the factors involved in survival outcome of the cardiac arrest patients, the favorable outcome have been found to be associated with, witnessed cardiac arrest, short duration between collapse and initiation of resuscitation, short duration of arrest and larger time interval between arrests in-case of multiple arrests [4,5,6]. There is scant evidence concerning the relationship between initial documented rhythms and survival-to-discharge rates after IHCA.
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