Antecedents to cardiac arrests in a teaching hospital Intensive Care Unit.

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Antecedents to cardiac arrests in a teaching hospital Intensive Care Unit.

Resuscitation. 2013 Dec 7;

Authors: Rozen TH, Kaufman M, Warrillow S, Bellomo R, Jones DA, Hsiao YF, Mullane S

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 12hours prior to CA, index patients had higher maximum (22 vs. 18 breaths/min; p=0.001) and minimum respiratory rates (16 vs. 12 breaths/min; p=0.031); a lower median mean arterial pressure (65 vs. 70mmHg; p=0.029) and systolic blood pressure (97 vs. 106mmHg; p= 0.033); a higher central venous pressure (14 vs. 11cmH2O; p= 0.008) and a lower bicarbonate level (20.5 vs. 26mmol; p=0.018) compared to controls. CA patients also had a higher maximum dose of noradrenaline (norepinephrine) (17.5 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 48hr 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%.

PMID: 24326274 [PubMed - as supplied by publisher]

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