Cardiac arrests within the emergency department: an Utstein style report, causation and survival factors

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Abstract

Background

Emergency Department Cardiac Arrests are typically classified with in-hospital cardiac arrests, but are yet to be well described as a distinct clinical entity. This study provides an Utstein style report on Emergency Department Cardiac Arrests, and identifies factors associated with survival.

Patients and methods

Patients who experienced a cardiac arrest in the Emergency Department of the National University Hospital, Singapore, between January 2010 and August 2012 were studied. Data were collected retrospectively and potential survival factors were assessed with a multivariate logistic regression.

Results

One hundred and six cases were identified for analysis. Most patients were male and 43.4% had a presumed cardiac diagnosis. All arrests were witnessed and received Advanced Cardiac Life Support interventions immediately. Out of the total, 31.1% of arrests occurred during or immediately after intubation. Overall, 48.1% of patients survived to hospital discharge. Patients with a shockable rhythm had the highest survival rate (70.8%), followed by asytole (20.8%) and pulseless electrical activity (15.1%). In all, 91.3% of survivors with a premorbid Cerebral Performance Category score of 1 were discharged with a similar Cerebral Performance Category score.

Results

Variables associated with survival to hospital discharge were a shockable initial rhythm (odds ratio 12.1; 95% confidence interval, 3.1–47.6) and a time to return of spontaneous circulation of less than 10 min (odds ratio 4.1; 95% confidence interval, 1.0–16.9).

Conclusion

This is the first Utstein style report on Emergency Department Cardiac Arrests. A high survival rate with good neurological outcomes was found in this population. The initial rhythm and time to return of spontaneous circulation have been identified as survival factors and may be used to guide decision-making during resuscitation.

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