Causes of in-hospital cardiac arrest – Incidences and rate of recognition

Bergum, Daniel; Nordseth, Trond; Mjølstad, Ole Christian; Skogvoll, Eirik; Haugen, Bjørn Olav

doi:10.1016/j.resuscitation.2014.11.007

Cited by 97 publications

(103 citation statements)

References 26 publications

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“…19,20 In many IHCA studies the proportion of witnessed/observed cardiac arrests has been as high as 85-92% and it has been discussed, that previous IHCA studies represent poorly the actual patient population on general wards because of the high proportion of ICU/emergency department/cardiac care unit patients. 9,20,21 Brindley et al excluded patients allocated to 'critical care units' and found that 58% of the IHCAs were witnessed/observed, which is in line with our findings. 19 Still, two thirds of patients experiencing a witnessed/observed cardiac arrest on general wards is rather high.…”

Section: Discussionsupporting

confidence: 91%

“…Cardiac causes were still more common than non-cardiac causes, however approximately 10% less prevalent than reported in studies including all hospital departments. 9,10 Of the specific causes of IHCAs, acute myocardial infarction and myocardial ischaemia without later findings of infarction together accounted for 35% of the arrests. This finding is of utmost importance, considering that only 15% of all general ward IHCAs had a shockable primary rhythm.…”

Section: Discussionmentioning

confidence: 99%

“…Bergum et al studied 258 IHCAs and found cardiac causes to be responsible for 60% of the IHCAs. 9 Wallmuller et al reported similarly the percentage to be 63, and cardiac aetiology was associated with better outcome. 10 However, in these thorough studies only 50% and 19% of IHCAs occurred on general wards while the rest occurred in specialized departments inside hospital like emergency departments, intensive care units and post anaesthetic care units.…”

Section: Introductionmentioning

confidence: 92%

“…10 However, in these thorough studies only 50% and 19% of IHCAs occurred on general wards while the rest occurred in specialized departments inside hospital like emergency departments, intensive care units and post anaesthetic care units. 9,10 The aim of this study was to shed light on the aetiology and antecedents to IHCAs occurring on hospital's general wards and investigate, whether the aetiology and antecedents are associated with outcome. …”

Section: Introductionmentioning

confidence: 99%

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Aetiology of in-hospital cardiac arrest on general wards

et al. 2016

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a b s t r a c tAim: Aetiology of in-hospital cardiac arrests (IHCAs) on general wards has not been studied. We aimed to determine the underlying causes for IHCAs by the means of autopsy records and clinical judgement of the treating consultants. Furthermore, we investigated whether aetiology and preceding vital dysfunctions are associated with long-term survival. Design and setting: Prospective observational study between 2009-2011 including 279 adult IHCA patients attended by medical emergency team in a Finnish university hospital's general wards. Results: The median age of the patients was 72 (64, 80) years, 185 (66%) were male, 178 (64%) of events were monitored/witnessed, first rhythm was shockable in 42 (15%) cases and 53 (19%) patients survived six months. Aetiology was determined as cardiac in 141 events, 73 of which were due to acute myocardial infarction. There were 138 non-cardiac IHCAs; most common causes were pneumonia (39) and exsanguination (16). No statistical difference was observed in the incidence of objective vital dysfunctions preceding the event between the cardiac and non-cardiac groups (40% vs. 44%, p = 0.448). Subjective antecedents were more common in the cardiac cohort (47% vs. 32%, p = 0.022), chest pain being an example (11% vs. 0.7%, p < 0.001). Reviewing all 279 IHCAs, only shockable primary rhythm, monitored/witnessed event and low comorbidity score were independently associated with 180-day survival. Conclusions: Cardiac aetiology underlies half of the IHCAs on general wards. Both objective and subjective antecedents are common. However, neither the cardiac aetiology nor the absence of preceding deterioration of vital signs were factors independently associated with a favourable outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Aetiology of in-hospital cardiac arrest on general wards

et al. 2016

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“…Hypoxemia and acidosis typically contribute to persistent or recurrent pulseless electrical activity during prolonged cardiac arrest, although hypoxemia may cause almost 25% of arrests attributed to pulseless electrical activity. 65,66,68,69 The pulse rate and QRS width on ECG can provide useful clues in regard to the cause of nontraumatic pulseless electrical activity (Figure 1). 62 Reversible causes (pseudopulseless electrical activity from profound shock) often produce tachycardia with visible P waves and a narrow QRS complex (tachycardic pulseless electrical activity with a supraventricular rhythm).…”

Section: Interventionsmentioning

confidence: 99%

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

Jentzer

Clements

Wright

et al. 2016

Annals of Emergency Medicine

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Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

Patel

Atti

Kumar

et al. 2019

Cathet Cardio Intervent

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Background Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in‐hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra‐aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12‐fold increase and three‐fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven‐year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non‐MCS groups. Conclusion There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non‐MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

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Causes of in-hospital cardiac arrest – Incidences and rate of recognition

Abstract: Various cardiac and hypoxic aetiologies dominated. In two-thirds of IHCA episodes, the underlying cause was correctly identified by the ET, i.e. according to the findings of the aetiology study group.

Cited by 97 publications

References 26 publications

Aetiology of in-hospital cardiac arrest on general wards

Aetiology of in-hospital cardiac arrest on general wards

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

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