Cardiac Arrest in the Critically Ill. I. A Study of Predisposing Causes in 132 Patients

Int J of Nursing Practice

Mohr

Lourenco

et al. 2013

The study aims to identify the reasons for, and outcomes from, unplanned transfers from subacute care to acute care. A retrospective patient record review of patients requiring unplanned transfer from subacute to an acute care emergency department (ED) from 1 July 2008 to 30 June 2009 was undertaken. Data collected included patient demographics, clinical characteristics in preceding transfer, and on ED arrival and outcome data. There were 136 patients included in the study with a median age of 81 years. The most common reasons for transfer were respiratory problems and altered conscious state. In the 24 h preceding transfer, 92.6% of patients had ≥ 1 physiological abnormality and 10.3% of patients had no physiological parameters documented. On ED arrival, 75% of patients had physiological abnormalities. Hospital admission occurred in 75% of patients and the inpatient mortality rate was 14.7%. Factors associated with inpatient mortality were tachypnoea and severe hypoxaemia in 24 h preceding transfer and tachypnoea, hypoxaemia, hypoxaemia, severe hypoxaemia and hypothermia on ED arrival. Patients requiring unplanned transfer had higher inpatient mortality than older hospital users. Reasons for unplanned transfer reflect known predictors of in-hospital adverse events so predictive use of physiological data and patient characteristics might optimize patient safety.

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients requiring unplanned transfer from subacute to acute care

Int J of Nursing Practice

Mohr

Lourenco

et al. 2013

“…In a study by Sax and Charlson (1987), the rate of cardiac arrest in patients admitted with acute dyspnoea was 22%, which is dramatically higher than the 3·5% cardiac arrest rate in patients admitted for other reasons ( P < 0·001). As discussed previously, this is significant, given the inherently high mortality associated with cardiac arrest (Camarata et al. 1971, Bedell et al.…”

Section: Dyspnoeamentioning

confidence: 98%

“…Despite advances in resuscitation over recent decades, survival rates following in‐hospital cardiac arrest have not improved. Only 43% of patients survive initial resuscitation and approximately 13% of patients survive and are discharged from hospital (Camarata et al. 1971, Bedell et al.…”

Section: Effect Of Respiratory Dysfunction Prior To Adverse Events Onmentioning

confidence: 99%

The role of nurses in preventing adverse events related to respiratory dysfunction: literature review

Journal of Advanced Nursing

2005

The way in which nurses assess, document and use clinical indicators of respiratory dysfunction is influential in identifying patients at risk of an adverse event and preventing adverse events related to respiratory dysfunction. If such adverse events are to be prevented, nurses must not only be able to recognise and interpret signs of respiratory dysfunction, but must also take responsibility for initiating and evaluating interventions aimed at correcting respiratory dysfunction.

“…The results of this multi‐site study highlight four major issues for ED oxygen management of patients with COPD. First, a considerable number of patients in this study with documented hypoxaemia (oxygen saturation less than 90%) did not receive oxygen: 61.8% on ED arrival, 30% at 1 h and 45.5% at 4 h. Reluctance to administer supplemental oxygen is concerning, particularly as hypoxaemia is a known antecedent to adverse events 41–45 . Although the boundaries for acceptable levels of hypoxaemia may be lower in patients with COPD 19,46 life‐threatening hypoxaemia should be treated using controlled oxygen therapy to achieve target oxygen saturation 10,12–15,19,47 …”

Section: Discussionmentioning

confidence: 99%

Descriptive analysis of emergency department oxygen use in acute exacerbation of chronic obstructive pulmonary disease

Internal Medicine Journal

Botti

Thomas

2012