Background: Recent studies have suggested that the incidence of in-hospital pulseless electrical activity (PEA) arrests is increasing. Bradycardia in patients with in-hospital PEA is common but it is unknown if it is associated with patient outcomes.
Objective: To determine risk factors and outcomes associated with bradycardic-PEA arrests.
Methods: This was a retrospective study of all inpatient cardiac arrests at an academic medical center. Patient demographics, comorbidities, vital signs, arrest event data, and outcomes were abstracted from the medical record. PEA arrest was defined as a non-shockable rhythm with loss of pulse requiring cardiopulmonary resuscitation and having organized electrocardiographic activity. Bradycardia was classified as a HR < 60 bpm at the time of pulse loss. Obvious vasovagal events were excluded. The primary outcomes were survival of arrest and survival to hospital discharge.
Results: Between July 2013 and August 2017, there were 176 in-hospital PEA arrests. While 105 (59.7%) survived the arrest, only 38 (21.6%) survived to discharge. A total of 65 (36.9%) were bradycardic-PEA arrests. Bradycardia was associated with improved survival to hospital discharge (χ2 8.60, p=0.003), but not survival of arrest (χ2 2.15, p=0.14). Hypoxemia increased (OR 2.72, 95% CI: 1.26-5.87, p=0.01) and a cardiac implanted electronic device decreased (OR 0.17, 95% CI: 0.04-0.78, p = 0.02) the odds of an arrest being preceded by bradycardia. On multivariate analysis, bradycardia remained a predictor of survival to discharge (OR 2.46, 95% CI 1.14-5.32, p=0.02). Other predictors of survival to discharge included hypoxemia (OR 3.38, 95% CI 1.45-7.89, p=0.005) and coronary artery disease (OR 2.29, 95% CI 1.03-5.09, p=0.04).
Conclusion: While a significant proportion of hospitalized patients survive a PEA arrest, many fewer survive to discharge. Bradycardia at the time of PEA arrest was associated with improved survival to discharge but not survival of arrest. Bradycardia was associated with hypoxemic arrests, in which rapid airway management should be a priority to improve the chance of successful resuscitation.