Abstract 240: Electrocardiogram Changes Associated With In-Hospital Cardiac Arrests due to Respiratory Failure
Introduction: The estimated incidence of in-hospital cardiac arrests (IHCA) in US is over 200,000 annually. Respiratory related causes contribute to approximately 15% of IHCAs. Many arrests due to respiratory problems may be preventable. Thus it may be beneficial to develop methods that can identify patients at increased risk of developing respiratory related cardiac arrests particularly if clinical signs are undetected or develop rapidly.
Hypothesis: ECG changes preceding respiratory related cardiac arrests may alert caregivers of an impending cardiac arrest when other clinical signs are not apparent.
Methods: We reviewed all IHCA cases that occurred between April 2010 and March 2012 at UCLA Medical Center in patients age > 18 years, with ECG data available at least 3 hours prior to and including the IHCA, and further analyzed cases related primarily to respiratory failure as determined by chart review. ECG data was analyzed for ECG changes prior to arrest.
Results: Respiratory failure was designated as the primary cause in 17/65 (26%) of IHCAs reviewed. Of these, the mechanism of IHCA was pulseless electrical activity (PEA) in 70%, and bradyasystolic arrest in 30%; there were no ventricular tachycardia/ventricular fibrillation (VT/VF) arrests. The causes of respiratory failure included: mucous plug (41.2%), aspiration (35.3%), and pneumonia (23.5%). At least one ECG change preceding the arrest was seen in 88% of cases, and at least two ECG changes preceding the arrest was seen in 47% of cases, with an average of 1.6 ECG changes per case.
Conclusions: At least one significant ECG change was recorded in approximately 90% of IHCA cases due to respiratory arrest with a median time of approximately 13 minutes prior to the arrest. This may provide an additional alert to physicians and nurses of impending cardiac arrest, and allow for earlier detection and intervention.
- © 2013 by American Heart Association, Inc.