Document Type: Original Article

Authors

1 Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

2 Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Abstract

Objective: Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low. The use of initial documented cardiac rhythm as predictor of Survival-to-discharge is still unclear. This study aimed to assess whether the initial documented rhythm can be used as a predictor of survival-to-discharge following IHCA in an emergency department of the tertiary care referral institute, south India. Methods: This observational study was conducted for six months from January to June 2017 among all patients above 12 years, with witnessed cardiac arrest after arrival at the emergency department. After obtaining informed consent from the patients’ caregivers, data of socio-demographic details, previous relevant medical history, initial documented rhythm, neurologic status and survival-to-discharge were collected and analyzed. Results: The mean age of participants was 50 ± 17.15 years. Of the 252 study participants, 77.4% had non-shockable and 22.6% had shockable rhythm as initial documented rhythm. The overall survival-to-discharge rate was 17.5% (n=44) in our study. The overall proportion of participants who survived to discharge after IHCA was higher among participants with shockable rhythm (16/57, 28%) in comparison to participants with non-shockable rhythm (28/195, 14.3%). These differences were found to be statistically significant. Among the patients with shockable rhythm, 61.1% had good cerebral performance. Conclusion: Survival-to-discharge rates after IHCA can be predicted based on the initial documented cardiac rhythm. Early identification of patients with impending cardiac arrest and providing prompt management of patients with cardiac arrest will improve the survival rates significantly

Keywords

Main Subjects

1. Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009; 361(1): 22-31. doi: 10.1056/NEJMoa0810245.

2. Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation 2012; 125(4): 620-37. doi: 10.1161/circulationaha.111.023838.

3. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 2007; 33(2): 237- 45. doi: 10.1007/s00134-006-0326-z.

4. Cooper S, Janghorbani M, Cooper G. A decade of inhospital resuscitation: outcomes and prediction of survival? Resuscitation 2006; 68(2): 231-7. doi: 10.1016/j. resuscitation.2005.06.012.

5. Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med 2010; 38(1): 101-8. doi: 10.1097/CCM.0b013e3181b43282.

6. Brady WJ, Gurka KK, Mehring B, Peberdy MA, O’Connor RE. In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation 2011; 82(7): 845-52. doi: 10.1016/j.resuscitation.2011.02.028.

7. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med 2012; 367(20): 1912-20. doi: 10.1056/ NEJMoa1109148.

8. Johnson S, Nileshwar A. Initial rhythm and outcome of in-hospital adult cardiac arrest in a tertiary care hospital. Indian Journal of Respiratory Care 2014; 3(1): 421-5.

9. Afshar F. Brain Failure & Resuscitation. J R Soc Med 1982; 75(6): 485.

10. Bayés de Luna A, Coumel P, Leclercq JF. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 1989; 117(1): 151-9. doi: 10.1016/0002-8703(89)90670-4. 11. Herlitz J, Bång A, Ekström L, Aune S, Lundström G, Holmberg S, et al. A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome. J Intern Med 2000; 248(1): 53-60. doi: 10.1046/j.1365-2796.2000.00702.x.

12. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003; 58(3): 297-308. doi: 10.1016/s0300- 9572(03)00215-6.

13. Holmgren C, Bergfeldt L, Edvardsson N, Karlsson T, Lindqvist J, Silfverstolpe J, et al. Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden. Heart 2010; 96(22): 1826-30. doi: 10.1136/hrt.2010.198325.