Abstract 50: Risk of Cardiopulmonary Arrest after Acute Respiratory Compromise
INTRODUCTION: Many hospitalized patients experience acute respiratory compromise (ARC), with a portion developing cardiopulmonary arrest (CPA) despite emergent care. We sought to characterize the clinical course of ARC patients and their risk of developing CPA. We hypothesized that a substantial portion of ARC patients develop CPA and that CPA occurs rapidly after ARC onset.
METHODS: We used ARC data from the National Registry of Cardiopulmonary Resuscitation (NRCPR), a multicenter registry describing inhospital adults requiring emergency assisted ventilation. For each primary ARC event we identified patient characteristics (age, sex, race, ethnicity, weight), clinical presentation (ECG, conscious or breathing, witnessed event, location of event), suspected cause and acute interventions (airway, respiratory and medications). The primary outcome was the development of CPA. Secondary outcomes were time to CPA and survival to discharge. We also identified factors associated with developing CPA. We used descriptive statistics and multivariate logistic regression.
RESULTS: Of 4,358 ARC events, CPA occurred in 726 (16.7%; 95% CI: 15.6 –17.8%). Median time from ARC onset to CPA was 7 minutes (IQR: 3–14 min); CPA occurred within 10 minutes in 65.3% of these cases. Survival to discharge was lower for CPA patients than non-CPA patients; 14.3% vs. 58.4% (OR death 8.3, 95% CI: 6.7–10.4). Multivariate factors associated with CPA included failed invasive airway (OR 10.5; 95% CI: 6.9 –16.1), tracheostomy or cricothyroidotomy (7.1; 2.4 –21.6), pulmonary embolism (3.4; 1.9 – 6.0), hypotension (1.7; 1.4 –2.1), ECG of bradycardia (2.4; 1.8 –3.0), paced (2.7; 1.7– 4.4) or idioventricular (2.7; 1.3–5.8), and use of magnesium sulfate (2.7; 1.2– 6.0). CPA was less likely when patients were conscious (0.8, 0.6 –1.0) or breathing (0.4, 0.3– 0.6) or if sedative induction agents were used (0.4, 0.3– 0.5).
CONCLUSIONS: CPA occurs frequently and rapidly after ARC and is associated with airway management complications, hypotension, bradycardias and pulmonary embolism. Survival to discharge after ARC-related CPA is low. Medical teams responding to ARC should prepare not only for airway management but also the possibility of CPA.