Cardiac Arrest in the Critically Ill

Abstract

The events preceding cardiac arrest were investigated in 132 critically ill patients on the basis of the hemodynamic, respiratory, and metabolic status prior to cardiac arrest. Approximately one-half of the patients had respiratory acidosis prior to cardiac arrest and only one of these patients ultimately survived. An additional one-fourth had metabolic acidosis due to progressive perfusion failure (shock), and none survived. In the remaining one-fourth, an immediate catastrophic and potentially preventable event accounted for cardiac arrest, and all but one of the long-term survivors were included in this group. In thirteen patients, obstruction or dislodgment of endotracheal tracheostomy tubes, or interruption of ventilation, was recognized as the immediate cause. In an additional 20 patients, cardiac arrest was associated with an adverse effect of a drug. Twelve instances of cardiac arrest were associated with central venous injection of aminophylline.The initial cardiac resuscitation attempt was effective in 38% of patients. However, the majority of patients who survived the first episode succumbed after a second or third episode. The cumulative survival was disappointingly small. Only six patients, or 5% of the total group of 132 patients, were long-term survivors. These data may provide the basis for more restricted use of routine and repetitive resuscitative measures particularly for elderly patients in whom circulatory failure.acidemia is due to progressive ventilatory or Additional

Factors and outcomes associated with inpatient cardiac arrest following emergent endotracheal intubation

“…Patients in a state of shock may not tolerate the decreased cardiac preload and venous return that results from increased intra-thoracic pressure related to positive pressure ventilation,. Physiologic changes in the critically ill such as profound acidosis may also play a role (12) where an inadvertent reduced respiratory rate with intubation leads to a further decrease in pH. In addition, critically ill patients sustaining themselves on high endogenous catecholamine output may undergo a sympatholytic state where the removal of stressful stimulus through sedation or a paralytic induces cardiac arrest (13).…”

Comparison of one versus two bronchodilators in ventilated COPD patients

“…The latter induced significant changes in cardiac frequency. For this reason and the various well known side-effects of this drug [9][10][11][12][13] we decided to administer a combination of bronchodilating drugs by inhalation, since this is the best route of administration.…”

Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards

“…Previous studies have reported several mechanisms involving PICA in Emergency Department settings [ 14 - 17 ], describing that cardiac arrest patients may not tolerate decreased preload and reduction of venous return, which are triggered by an increase in intrathoracic pressure when positive pressure ventilation is applied in patients with shock after intubation [ 18 ]. It can also result from physiological changes due to severe diseases such as acidosis, which can be exacerbated upon respiratory compensation being compromised when respiratory rate and effective respiratory response are negatively affected during intubation.…”