Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Chia-Te Kung,Jien-Wei Liu,Hung-Yi Chuang,Chao-Jui Li,Hsien-Hung Cheng,Shin-Chiang Hung,Chu-Feng Liu,Fu-Cheng Chen,Chih-Min Su

doi:10.4236/ijcm.2014.519157

Abstract

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

Highlights

According to the Get with the Guidelines (GWTG)-Resuscitation registry, overall survival after in-hospital cardiac arrest (IHCA) has improved significantly during the past decade [1] [2]
A total of 544 adult patients with IHCA occurring in general wards were analyzed for the event variables and resuscitation results (Figure 1)
The initial rhythms recorded when the event took place were pulseless electrical activity (PEA) for over half of the patients (61.7%), while Ventricular tachycardia/ventricular fibrillation (VT/ventricular fibrillation (VF)) was recorded in only 3.9% of patients

Summary

Introduction

According to the Get with the Guidelines (GWTG)-Resuscitation registry, overall survival after in-hospital cardiac arrest (IHCA) has improved significantly during the past decade [1] [2]. The patient outcome after IHCA in general ward remains poor with only 3% - 14% of patients undergoing cardiopulmonary resuscitation (CPR) being able to survive and be discharged [3] [9] [10]. Established outcome predictors for patients with IHCA such as adequate monitoring may not be applied to those in the general wards. Few studies have focused on factors influencing outcome of patients with IHCA in general wards [9] [10]. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards of an Asian medical center in comparison to those in western countries

Methods

Results

Discussion

Conclusion