2006 OPEN FORUM Abstracts
ANTECEDENTS OF IN-HOSPITAL CARDIAC ARREST: AN EXPERIENCE OF A TERTIARY CARE CRITICAL CARE OUTREACH SERVICES TEAM
AFZAL AZIM, MD; ANAND KUMAR, MD; ARVIND K. BARONIA, MD;
MOHAN GURJAR, MD; BANANI PODDAR, MD; SHIV S. TRIPATHI, MD.
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow , India .
Mortality from cardiac arrest is high in-spite of marked improvements in standardization of training of hospital staff in cardiopulmonary resuscitation. A little attention has been given to the preventive aspect of cardiac arrests. Early recognition of clinical and pathophysiological antecedent might evolve a rational approach to the prevention of arrest, strategies in resuscitation or the timely involvement of the family member in decision to do not resuscitate. With this objective we conducted a retrospective analysis of all the cardiac arrests occurring in wards and for whom call for resuscitation was received by our outreach services team.
MATERIALS & Methods:
We studied 80 cases of in-hospital cardiac arrest over a period of 12 months attended by our outreach services team for cardiopulmonary resuscitation in a superspeciality centre with emphasis on events preceding arrest. All cases included in this study had minimal hospital stay of 12 hours. Cardiac arrests in post operative recovery room, intensive care unit or emergency room were not included in the study. All cases where diagnostic workup was not available were excluded from the study. Retrospective analysis of all the cases was done as per their medical records including treating physician comments, resident doctor's clinical findings and orders. Nursing observations, actions and investigations available in last 24 hours were noted. All cases were followed till their hospital stay or death.
Total of 80 patients suffered cardiac arrest against 13,000 hospital admissions (0.61%). Mean age of the patients was 50.6 years ranging from 4 to 80 years. Male to Female ratio was 2:1. Majority (31.6%) of the calls were received from the Nephrology department followed by Neurology and Gastroenterology. Hypertension (40%) was most common co-morbid illness in the patients followed by diabetes (28%). Co-existent diabetes and hypertension were present in 20% of the patients. Other co-morbid illnesses included coronary artery disease, COPD and acute renal failure. Amongst the physiological parameters tachycardia (55%) was most deranged parameter and total leucocytes count was abnormal in 46% of the patients. The other deranged physiological parameters contributing to cardiac arrest were tachypnoea (32.6%) and poor neurological status (35%). Significant hypoxemia (PaO2 <60 mmHg) despite oxygen therapy was present in 15 patients (19%). Amongst the electrolytes potassium was deranged in maximum number of patients (36%). Only 35 patients could be successfully resuscitated. Twenty one patients out of 35 (60%) expired within 48 hours of resuscitation. Ten patients were shifted to intensive care unit out of which 6 patients survived but were discharged in vegetative state. Four patients were discharged from the ward without any consequences of cardiac arrest. Among all the patients 30 patients (37.5%) had avoidable risk factor for cardiac arrest. Twenty two (27.5%) patients were fitting into the Modified Early Warning Score (MEWS) of 1-3 and 18 patients (22.5%) were having score of ≥4. No change in routine management or monitoring were done in any patient.
In hospitalized patients majority of cardiac arrests are preceded by premonitory signs and symptoms. Introduction of MEWS or some scoring system applicable locally for the nursing staff can help in early recognition of the antecedent factor for which timely intervention can be done. More attention should be towards prevention of cardiac arrest rather than only training in cardiopulmonary resuscitation.