Roshini Ravindran1, Chun Shing Kwok2, Chun Wai Wong1, Jolanta M Siller-Matula3, Purvi Parwani4, Poonam Velagapudi5, David L Fischman6, Chadi Alraies7, Erin D Michos8, Mamas A Mamas9. 1. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK. 2. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK. Electronic address: shingkwok@doctors.org.uk. 3. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland. 4. Division of Cardiology, Department of Medicine, Loma Linda University Medical Health, Loma Linda, CA, USA. 5. Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. 6. Department of Cardiology, Jefferson University, Philadelphia, USA. 7. Division of Cardiology, Wayne State University, Detroit Medical Center Heart Hospital, Detroit, Michigan, USA. 8. Division of Cardiology Department of Medicine, Johns Hopkins University School of Medicine Baltimore MD, USA. 9. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Abstract
AIMS: The aim of this study is to analyse the causes of cardiac arrests (CA) in the emergency departments (ED) in the United States and their clinical outcomes according to whether they had a primary or a secondary diagnosis of CA. METHODS: Data from the Nationwide Emergency Department Sample was assessed for episodes of CA in the emergency department (ED) for adults from 2006 to 2014. Primary and secondary diagnoses of CA and mortality outcomes were evaluated in ED, inpatient and the combined in-hospital setting. RESULTS: There were 2,852,347 ED episodes with a diagnosis of CA (50.5% primary diagnosis, 49.5% secondary diagnosis). Among patients with a secondary diagnosis of CA, ∼33% patients had a primary cardiac diagnosis, followed by infectious and respiratory diagnoses. The survival to ED discharge was 53.2%; lower for primary versus secondary CA diagnosis (20.4% vs 86.7%). The in-hospital survival rate for all CA was 28.7%, and was lower for primary versus secondary CA diagnosis (15.7% vs 41.9%). Survival to hospital discharge was highest in the age group of 41-60 years (33.0%) and was least among >80 years (20.9%). Survival was also noted to be lower among female patients (27.9% vs 29.2%) and in the winter months. CONCLUSIONS: Survival with CA in ED is <30% of patients and is greater among patients with a secondary diagnosis of CA. CAs are associated with significant mortality in ED and hospital settings and measures should be taken to better manage cardiac, infection and respiratory causes particularly in the winter months.
AIMS: The aim of this study is to analyse the causes of cardiac arrests (CA) in the emergency departments (ED) in the United States and their clinical outcomes according to whether they had a primary or a secondary diagnosis of CA. METHODS: Data from the Nationwide Emergency Department Sample was assessed for episodes of CA in the emergency department (ED) for adults from 2006 to 2014. Primary and secondary diagnoses of CA and mortality outcomes were evaluated in ED, inpatient and the combined in-hospital setting. RESULTS: There were 2,852,347 ED episodes with a diagnosis of CA (50.5% primary diagnosis, 49.5% secondary diagnosis). Among patients with a secondary diagnosis of CA, ∼33% patients had a primary cardiac diagnosis, followed by infectious and respiratory diagnoses. The survival to ED discharge was 53.2%; lower for primary versus secondary CA diagnosis (20.4% vs 86.7%). The in-hospital survival rate for all CA was 28.7%, and was lower for primary versus secondary CA diagnosis (15.7% vs 41.9%). Survival to hospital discharge was highest in the age group of 41-60 years (33.0%) and was least among >80 years (20.9%). Survival was also noted to be lower among female patients (27.9% vs 29.2%) and in the winter months. CONCLUSIONS: Survival with CA in ED is <30% of patients and is greater among patients with a secondary diagnosis of CA. CAs are associated with significant mortality in ED and hospital settings and measures should be taken to better manage cardiac, infection and respiratory causes particularly in the winter months.