Acute Respiratory Compromise in the Emergency Department: A Description and Analysis of 3571 Events from the Get With the Guidelines–Resuscitation ® Registry

Abstract

Background Respiratory events requiring the use of assisted ventilation are relatively common in the emergency department (ED), and can be associated with substantial morbidity and mortality. Objective The aim of this study was to describe and elucidate patient and event characteristics associated with mortality and progression to cardiac arrest in ED patients with acute respiratory compromise. Methods Data were obtained from the multi-center Get With the Guidelines–Resuscitation® registry. We included patients with acute respiratory compromise defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation. All adult patients between January 2005 and December 2014 with an index event in the ED were included. We used multivariable logistic regression models to assess the association between patient and event characteristics and in-hospital mortality, with cardiac arrest during the event as a secondary outcome. Results A total of 3571 events were included. The in-hospital mortality was 34%. Twelve percent of events progressed to cardiac arrest, with a subsequent 82% in-hospital mortality. When adjusting for patient and event characteristics, we found no temporal changes in in-hospital mortality from 2005 to 2014. Several characteristics were associated with increased mortality, such as pre-event hypotension, septicemia, and acute stroke. Similarly, multiple characteristics, including pre-event hypotension, were associated with progression to cardiac arrest. Conclusions Patient with acute respiratory compromise in the ED had an in-hospital mortality of 34% in the current study. These patients also have a high risk of progressing to cardiac arrest, with a subsequent increase in in-hospital mortality to 82%. Potentially reversible characteristics, such as hypotension before the event, showed a strong association to in-hospital mortality, along with multiple other patient and event characteristics.

Unanticipated Respiratory Compromise and Unplanned Intubations on General Medical and Surgical Floors

“…Respiratory compromise is common in the hospital and a frequent reason for urgent intervention. 2,3 Although most of these events occur in intensively monitored units and in patients thought to be at risk for respiratory compromise based on various prediction models 4,5 ; they can also occur on lightly monitored general care floors.…”