Antecedents to cardiac arrests in a teaching hospital intensive care unit

Thomas H. Rozen, Siobhan Mullane, Melissa Kaufman, Yu Feng Frank Hsiao, Stephen Warrillow, Rinaldo Bellomo, Daryl A. Jones

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13 Citations (Scopus)

Abstract

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 12h prior to CA, index patients had higher maximum (22breaths/min vs. 18breaths/min, p=0.001) and minimum respiratory rates (16breaths/min vs. 12breaths/min, p=0.031), a lower median mean arterial pressure (65mmHg vs. 70mmHg, p=0.029) and systolic blood pressure (97mmHg vs. 106mmHg, p=0.033), a higher central venous pressure (14cm H2O vs. 11cm H2O, p=0.008) and a lower bicarbonate level (20.5mmol vs. 26mmol, p=0.018) compared to controls. CA patients also had a higher maximum dose of noradrenaline (norepinephrine) (17.5mcg/min vs. 8.0mcg/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 48h 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%.

Original languageEnglish
Pages (from-to)411-417
Number of pages7
JournalResuscitation
Volume85
Issue number3
DOIs
Publication statusPublished - Mar 2014
Externally publishedYes

Keywords

  • Advanced life support (ALS)
  • Antecedents
  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Epidemiology
  • Intensive care

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