Abstract 113: A Descriptive Analysis of Vagal-Mediated Cardiopulmonary Arrest in the Inpatient Setting
Background: The etiology of inpatient cardiopulmonary arrest (CPA) is poorly understood. We hypothesized that a substantial proportion of inpatient arrests are mediated by excessive vagal tone due to a variety of stimuli in the inpatient environment.
Objective: To describe and define the incidence of vagal-mediated arrests as a subtype of CPA among hospitalized inpatients.
Methods: This study was performed in two urban, academic inpatient facilities. Patients were enrolled from July 2005-May 2013. A comprehensive database of all inpatient resuscitative events is maintained at these institutions and includes demographic, clinical, and outcomes data. For this analysis, all inpatient CPAs were included performance of cardiopulmonary resuscitation or defibrillation or the absence of a palpable pulse). Patients with “Do Not Attempt Resuscitation” orders were excluded. Arrests were stratified by etiology of arrest using a priori criteria. Arrest victims with a vagal etiology of arrest (bradycardia or asystole in response to a specific stimulus and in the absence of antecedent hypotension or hypoxemia) were further described.
Results: A total of 65 CPAs were categorized as vagal-mediated. These comprised approximately 16% of total inpatient CPA during the study period. A total of 51% of these occurred in the ICU. Among precipitants of the vagal response included: patient repositioning, suctioning, and straining during a bowel movement. Survival-to-hospital-discharge was 58.5% among vagal-arrest victims.
Conclusion: A substantial number of inpatient arrests are related to vagal stimulation. Suctioning, patient repositioning, and bowel movements appear to be risk factors for these events. These data have important implications for inpatient CPA algorithms, including the early administration of atropine, as well as training and monitoring strategies for high-risk patients. Future exploration of the clinical risk factors predisposing certain patients to vagal arrests as well as prophylactic administration of medications, such as glycopyrrolate, is also warranted.
- © 2013 by American Heart Association, Inc.