Early Cardiac Arrest in Patients Hospitalized With Pneumonia

Carr, Gordon; Yuen, Trevor C.; McConville, John F.; Kress, John P.; VandenHoek, T.; Hall, Jesse B.; Edelson, Dana P.

doi:10.1378/chest.11-1547

Cited by 43 publications

(20 citation statements)

References 45 publications

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“…Carr et al studied early cardiac arrest in patients hospitalized with pneumonia and found that the majority of patients had an arrhythmia in the absence of concurrent hypotension or respiratory distress. 27 However, their group found that the most common initial arrest rhythms were PEA and a systole and not shockable rhythms. Although this finding is not reflective of the higher proportion of VF/VT in our HD1 group, some episodes of PEA or a systole that were found may represent late detection of pulselessness and subsequent degeneration from a shockable arrest rhythm.…”

Section: Discussionmentioning

confidence: 99%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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Objective Define the frequency and survival pattern of cardiac arrests in relation to the hospital day of event and etiology of arrest. Subject and methods Retrospective cohort study of adult in-hospital cardiac arrests between July 1, 2005, and June 30, 2013, that were classified by etiology of deterioration. Arrests were divided based on hospital day (HD) of event (HD1, HD2–7, HD>7 days), and analysis of frequency was performed. The primary outcome of survival to discharge and secondary outcomes of return of spontaneous circulation (ROSC) and favorable neurological outcomes were compared using multivariable logistic regression analysis. Results A total of 627 cases were included, 193 (30.8%) cases in group HD1, 206 (32.9%) in HD2–7, and 228 (36.4%) in HD>7. Etiology of arrest demonstrated variability across the groups (p < 0.001). Arrests due to ventilation issues increased in frequency with longer hospitalization (p < 0.001) while arrests due to dysrhythmia had the opposite trend (p = 0.014). Rates of survival to discharge (p = 0.038) and favorable neurological outcomes (p = 0.002) were lower with increasing hospital days while ROSC was not different among the groups (p = 0.183). Survival was highest for HD1 (HD1: 38.9% [95% CI, 32.0–45.7%], p = 0.002 vs HD2–7: 34.0% [95% CI, 27.5–40.4%], p < 0.001 vs HD>7: 27.2% [95% CI, 21.4–33.0%], p < 0.001). Conclusions The etiology of cardiac arrests varies in frequency as length of hospitalization increases. Survival rates and favorable neurological outcomes are lower for in-hospital arrests occurring later in the hospitalization, even when adjusted for age, sex, and location of event. Understanding these issues may help with focusing therapies and accurate prognostication.

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Section: Discussionmentioning

confidence: 99%

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

et al. 2016

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“…These patients have greater hemodynamic instability and significantly increased short-term mortality. In another recent study of patients who suffered in-hospital cardiac arrest, the incidence of preexisting pneumonia was 12.1% [ 15 ]. In this study, a subset of these patients developed abrupt cardiac arrest without signs of hypotension, overt shock, respiratory failure, or severe metabolic derangements ( Figure 2 ).…”

Section: Abdominal Aortic Cross-clampingmentioning

confidence: 99%

The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair

Katseni

Chalkias

Kotsis

et al. 2015

BioMed Research International

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Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening medical problems. The aim of this review is to provide an overview of the effect of I/R injury on multiorgan failure following AAA repair. The PubMed, CINAHL, EMBASE, Medline, Cochrane Review, and Scopus databases were comprehensively searched for articles concerning the pathophysiology of I/R and its systemic effects. Cross-referencing was performed using the bibliographies from the articles obtained. Articles retrieved were restricted to those published in English. One of the most prominent characteristics of AAA open repair is the double physiological phenomenon of ischemia-reperfusion (I/R) that happens either at the time of clamping or following the aortic clamp removal. Ischemia-reperfusion injury causes significant pathophysiological disturbances to distant organs, increasing the possibility for postoperative multiorgan failure. Although tissue injury is mediated by diverse mechanisms, microvascular dysfunction seems to be the final outcome of I/R.

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“…The consequent early medical intervention (like early goal-directed therapy in septic patients [31]) on ward patients at risk may allow clinical improvement, prevent further deterioration, and finally reduce the hospital mortality. A recently published study on retrospective cardiac arrest registry data has compared in-hospital cardiac arrests occurred within 72 h of hospital admission in patients with (4,453) and without (32,645) preexisting pneumonia [32]. Only 36.5% of the patients with and 30% of those without preexisting pneumonia were receiving mechanical ventilation and only 33.3% of the patients with and 28.8% of those without preexisting pneumonia were receiving infusions of vasoactive drugs prior to cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…Only 36.5% of the patients with and 30% of those without preexisting pneumonia were receiving mechanical ventilation and only 33.3% of the patients with and 28.8% of those without preexisting pneumonia were receiving infusions of vasoactive drugs prior to cardiac arrest. These results show that more than half of the cardiac arrests occurred in the lack of overt shock and respiratory failure, suggesting the need of early recognition of clinical deterioration in patients with and without sepsis [32]. Moreover, it has long been shown that, in comparison with the patients developing septic shock in the ICU, those developing septic shock in general ward receive intravenous fluid boluses and vasoactive agents with clinically important delay [33].…”

Section: Discussionmentioning

confidence: 99%

Hospital staff education on severe sepsis/septic shock and hospital mortality: an original hypothesis

et al. 2012

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BackgroundSigns of serious clinical events overlap with those of sepsis. We hypothesised that any education on severe sepsis/septic shock may affect the outcome of all hospital patients. We designed this study to assess the trend of the mortality rate of adults admitted to hospital for at least one night in relationship with a hospital staff educational program dedicated to severe sepsis/septic shock.MethodsThis study was performed in six Italian hospitals in the same region. Multidisciplinary Sepsis Teams members were selected by each hospital management among senior staff. The education included the following steps: i) the Teams were taught about adult learning, problem based learning, and Surviving Sepsis guidelines, and provided with educational material (literature, electronic presentations, scenarios of clinical cases for training and booklets); ii) they started delivering courses and seminars each to their own hospital staff in the last quarter of 2007.To analyse mortality, we selected adult patients, admitted for at least one night to the wards or units present in all the study hospitals and responsible for 80% of hospital deaths. We fitted a Poisson model with monthly hospital mortality rates from December 2003 to August 2009 as dependent variable. The effect of the educational program on hospital mortality was measured as two dummy variables identifying a first (November 2007 to December 2008) and a second (January to August 2009) education period. The analysis was adjusted for a linear time trend, seasonality and monthly average values of age, Charlson score, length of stay in hospital and urgent/non-urgent admission.ResultsThe hospital staff educated reached 30.6% at the end of June 2009. In comparison with the pre-education period, the Relative Risk of death of the patient population considered was 0.93 (95% confidence interval [CI] 0.87-0.99; p 0.025) for in-patients in the first, and 0.89 (95% CI 0.81-0.98; p 0.012) for those in the second period after education.ConclusionOur hypothesis that a program educating hospital staff to early detection and treatment of severe sepsis/septic shock may affect the outcome of all hospital patients is original, but it has to be corroborated by other experiences.

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Early Cardiac Arrest in Patients Hospitalized With Pneumonia

Cited by 43 publications

References 45 publications

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing

The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair

Hospital staff education on severe sepsis/septic shock and hospital mortality: an original hypothesis

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