Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11983
Title: Antecedents to cardiac arrests in a teaching hospital intensive care unit.
Authors: Rozen, Thomas H;Mullane, Siobhan;Kaufman, Melissa;Hsiao, Yu-Feng Frank;Warrillow, Stephen;Bellomo, Rinaldo;Jones, Daryl A
Affiliation: Alfred Hospital, Commercial Road, Melbourne, Australia. Electronic address: tomrozen@gmail.com.
Austin Hospital, Australia.
Issue Date: 8-Dec-2013
Citation: Resuscitation 2013; 85(3): 411-7
Abstract: 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.To study the antecedents to, and characteristics of CAs in ICU.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.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 (22 breaths/min vs. 18 breaths/min, p=0.001) and minimum respiratory rates (16 breaths/min vs. 12 breaths/min, p=0.031), a lower median mean arterial pressure (65 mmHg vs. 70 mmHg, p=0.029) and systolic blood pressure (97 mmHg vs. 106 mmHg, p=0.033), a higher central venous pressure (14 cm H2O vs. 11 cm H2O, p=0.008) and a lower bicarbonate level (20.5 mmol vs. 26 mmol, p=0.018) compared to controls. CA patients also had a higher maximum dose of noradrenaline (norepinephrine) (17.5 mcg/min 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 48 h 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.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%.
Internal ID Number: 24326274
URI: http://ahro.austin.org.au/austinjspui/handle/1/11983
DOI: 10.1016/j.resuscitation.2013.11.018
URL: http://www.ncbi.nlm.nih.gov/pubmed/24326274
Type: Journal Article
Subjects: Advanced life support (ALS)
Antecedents
Cardiac arrest
Cardiopulmonary resuscitation (CPR)
Epidemiology
Intensive care
Aged
Case-Control Studies
Female
Heart Arrest.diagnosis
Hospitals, Teaching
Humans
Intensive Care Units
Male
Middle Aged
Prodromal Symptoms
Retrospective Studies
Appears in Collections:Journal articles

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