Causes of in-hospital cardiac arrest and influence on outcome

Resuscitation, 05/17/2012

Wallmuller C et al. – In hospital cardiac arrest is caused mainly by cardiac and pulmonary causes, outcome depends on the cause, with a big variability.

Methods

  • Retrospective analysis of resuscitation data, causes of cardiac arrest and outcome with a follow-up to 6months of a cardiac arrest registry in an emergency department of a tertiary care hospital, covering a 17.5-year period.

Results

  • Of 1041 patients, 653 were male (63%), the median age was 64years (IQR 53-73), 51% suffered cardiac arrest in the emergency department.
  • The first recorded rhythm showed PEA in 432 (41%), ventricular fibrillation in 404 (39%) and asystole in 205 (20%) patients.
  • Cardiac arrest of cardiac origin occurred in 63% of all patients, with 35% of them due to acute myocardial infarction.
  • Non-cardiac causes were mostly due to pulmonary causes (15% of all patients).
  • Aortic dissection/rupture, exsanguination, intoxication and adverse drug reactions, metabolic, cerebral, sepsis and accidental hypothermia each ranged between 1 and 4% of the cohort.
  • Of all patients, 376 (36%) were discharged in good neurologic condition.
  • Overall, patients with cardiac causes had a significantly better outcome than those with non-cardiac causes (44 vs. 23%, p<0.01).
  • Patients with pulmonary causes survived in 24%.
  • The other subgroups showed widely divergent survival results (3 to 65%).
  • Patients who had suffered cardiac arrest in the emergency department had a better outcome then patients of the regular ward or radiology department.

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