BACKGROUND: There is a paucity of data on patient outcomes following in-hospital cardiac arrest (IHCA) on the Internal Medicine clinical teaching unit (CTU). Accurate outcome data enhances discussions between patients, surrogates, and physicians, and assists in their management. METHODS: We performed a retrospective cohort study of consecutive "Code Blue" calls on 2 medical CTUs in a Canadian tertiary centre from January 1, 2003 to June 30, 2007. The medical records of identified patients were screened for eligibility and patient-specific and arrest-specific data were collected for eligible events. Primary outcome was survival to hospital discharge. RESULTS: Our cohort comprised 83 patients; including 54 (65.1%) men with a mean age of 75 years (range, 38-97). Infection (34.9%) was the principal reason for admission and over half of patients had 3 or more comorbid illnesses. Forty-three (51.8%) of the IHCA events were witnessed. In all, 39 (90.7%) of the witnessed and 36 (90%) of the unwitnessed arrests were pulseless electrical activity (PEA) or asystole (P = not significant). Return of spontaneous circulation occurred in 29 patients (34.9%) and 2 (2.4%) survived to hospital discharge. No patients survived to discharge after unwitnessed arrest. CONCLUSIONS: IHCA in Internal Medicine CTU patients is characterized by a high rate of PEA/asystole and a minimal chance of survival to hospital discharge. Moreover, no patient with an unwitnessed arrest survived to hospital discharge. While these findings require confirmation in a larger study, they merit consideration in the context of code status discussions, particularly with respect to the response to unwitnessed arrests.
BACKGROUND: There is a paucity of data on patient outcomes following in-hospital cardiac arrest (IHCA) on the Internal Medicine clinical teaching unit (CTU). Accurate outcome data enhances discussions between patients, surrogates, and physicians, and assists in their management. METHODS: We performed a retrospective cohort study of consecutive "Code Blue" calls on 2 medical CTUs in a Canadian tertiary centre from January 1, 2003 to June 30, 2007. The medical records of identified patients were screened for eligibility and patient-specific and arrest-specific data were collected for eligible events. Primary outcome was survival to hospital discharge. RESULTS: Our cohort comprised 83 patients; including 54 (65.1%) men with a mean age of 75 years (range, 38-97). Infection (34.9%) was the principal reason for admission and over half of patients had 3 or more comorbid illnesses. Forty-three (51.8%) of the IHCA events were witnessed. In all, 39 (90.7%) of the witnessed and 36 (90%) of the unwitnessed arrests were pulseless electrical activity (PEA) or asystole (P = not significant). Return of spontaneous circulation occurred in 29 patients (34.9%) and 2 (2.4%) survived to hospital discharge. No patients survived to discharge after unwitnessed arrest. CONCLUSIONS: IHCA in Internal Medicine CTU patients is characterized by a high rate of PEA/asystole and a minimal chance of survival to hospital discharge. Moreover, no patient with an unwitnessed arrest survived to hospital discharge. While these findings require confirmation in a larger study, they merit consideration in the context of code status discussions, particularly with respect to the response to unwitnessed arrests.
Authors: Corey R Fehnel; Alissa Trepman; Dale Steele; Muhib A Khan; Brian Silver; Susan L Mitchell Journal: J Clin Neurosci Date: 2018-05-19 Impact factor: 1.961
Authors: Reza Goharani; Amir Vahedian-Azimi; Behrooz Farzanegan; Farshid R Bashar; Mohammadreza Hajiesmaeili; Seyedpouzhia Shojaei; Seyed J Madani; Keivan Gohari-Moghaddam; Sevak Hatamian; Seyed M M Mosavinasab; Masoum Khoshfetrat; Mohammad A Khabiri Khatir; Andrew C Miller Journal: J Intensive Care Date: 2019-01-22