Abstract 114: Diurnal Variability in Inpatient Cardiopulmonary Arrest Incidence Based on Arrest Etiology
Introduction: Little information exists regarding inpatient cardiopulmonary arrest (CPA). We hypothesized that variability would exist in the incidence of CPA “after hours” due to the presence of fewer staff and potential reluctance to initiate diagnostic and therapeutic interventions.
Objective: To explore diurnal variability in CPA incidence for various arrest etiologies.
Methods: This study was performed in two urban, academic inpatient facilities, where a comprehensive database of all inpatient resuscitative events is maintained, including demographic, clinical, and outcomes data. Patients were enrolled from July 2005-June 2009. The Advanced Resuscitation Training (ART) Matrix classifies all inpatient resuscitation events based on the presumed etiology of deterioration. These taxonomy data allow for performance-improvement based training and the identification of trends that may require intervention. For this analysis, all inpatient cardiopulmonary arrests (absence of palpable pulse, performance of cardiopulmonary resuscitation, or defibrillation) were included. Patients with “Do Not Attempt Resuscitation” orders were excluded. Arrests were stratified by primary etiology of arrest using a priori criteria. Arrest etiology groups were compared with regard to baseline characteristics as well as time of arrest [“working hours” (7am-5pm) versus “after hours” (5pm-7am).
Results: A total of 332 CPA victims were enrolled during the study period. Arrests were equally likely to occur after hours versus working hours. owever, arrests due to sepsis were almost three times most likely to occur after hours (sepsis 2.7 times more likely, hemorrhage 0.9, pulmonary embolism 1, congestive heart failure 0.8, ventricular fibrillation 1.3, vagal 1.4, neurologic 1, respiratory 1.4). No diurnal variability was noted for other covariables.
Conclusions: Arrests due to sepsis are almost three times more likely to occur at night. This may reflect a difference in behavior among after-hours providers. Alternatively, this may represent a physiological phenomenon, such as diurnal variability in cortisol levels.
- © 2013 by American Heart Association, Inc.