Abstract P61: The Incidence and Etiology of Inpatient Cardiac Arrest
Background: Standard resuscitation guidelines are derived largely from the out-of-hospital cardiac arrest (OOHCA) population, with an emphasis on treating patients in ventricular fibrillation (VF)/pulseless ventricular tachycardia (PVT). Defining the optimal approach to inpatient cardiopulmonary arrest (CPA) requires better characterization of the etiology of arrest in this population.
Objective: To define the incidence and patterns for inpatient CPA.
Methods: This was a retrospective review of all inpatient CPAs in two academic medical centers over a 12-month time period. Data were abstracted from our inpatient resuscitation registry, which includes demographics, a detailed narrative of antecedent events, clinical resuscitation data, and outcomes. Patients with CPA were stratified into the following categories: primary VF/PVT, other primary dysrhythmias, bradyasystole with and without documented antecedent hypoxemia and/or hypotension, and other/unknown. The location and outcome of CPA was also recorded.
Results: A total of 122 CPAs were recorded over the 12-month study period, representing 5.8 CPAs per 1,000 discharges. Of these, 69 (56.6%) occurred outside an intensive care unit setting. A total of 65.6% of patients survived the initial resuscitative efforts. A total of 8 patients (6.7%) had a primary VF/PVT arrest; all but 1 of these occurred in a monitored setting. A total of 99 patients (81.1%) were noted to have hypoxemia and/or hypotension, ultimately resulting in a bradyasystolic arrest. An additional 9 patients (7.4%) had a bradyasystolic arrest but with unknown antecedent events, and 3 (2.5%) patients had a primary dysrhythmia other than VF/PVT. Inadequate information was available to determine the events surrounding the CPA for the remaining 3 patients.
Conclusions: The vast majority of inpatient CPA involves antecedent hypoxemia or hypotension ending with a bradyasystolic arrest. VF/PVT are relatively infrequent and generally occur in monitored settings. Inpatient resuscitation training should focus on the unique patterns of CPA in this population, with emphasis on early recognition and treatment of cardiovascular and respiratory deterioration.