Clinical antecedents to in-hospital cardiopulmonary arrest.

While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161 +/- 26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29 +/- 1 breaths per minute. The prognoses of patients' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.

[1]  Emergency service within the hospital. , 1957, Journal of the American Medical Association.

[2]  CARDIAC RESUSCITATION IN 126 MEDICAL PATIENTS USING EXTERNAL CARDIAC MASSAGE , 1964 .

[3]  Deovina N. Jordan,et al.  RESUSCITATION EXPERIENCE WITHIN THE HOSPITAL. , 1964, JAMA.

[4]  MILDEW ON THE LITTLE BLACK BAG , 1964 .

[5]  R. Sandoval.  Survival rate after cardiac arrest in community hospital. , 1965, JAMA.

[6]  N. Anthonisen,et al.  RESULTS OF CARDIAC RESUSCITATION IN 254 PATIENTS. , 1965, Lancet.

[7]  CARDIAC RESUSCITATION: A 1-YEAR STUDY OF PATIENTS RESUSCITATED WITHIN A UNIVERSITY HOSPITAL , 1966 .

[8]  Survival after cardiopulmonary resuscitation. , 1967, JAMA.

[9]  L. Siitonen,et al.  Resuscitation in cardiac arrest. An analysis of 100 successive medical cases. , 2009, Acta medica Scandinavica.

[10]  R. Ulan,et al.  Results of cardiac resuscitation in 552 patients. , 1967, The American journal of cardiology.

[11]  J. Hollingsworth.  The results of cardiopulmonary resuscitation. A 3-year university hospital experience. , 1969, Annals of internal medicine.

[12]  R. Jeresaty,et al.  External cardiac resuscitation in a community hospital. A three-year experience. , 1969, Archives of internal medicine.

[13]  C. Coakley,et al.  A Five Year Review of 734 Cardiopulmonary Arrests , 1970, Southern medical journal.

[14]  Cardiopulmonary resuscitation: A review of 184 cases and some applications for future improvements , 1970, Canadian Anaesthetists' Society journal.

[15]  B. Møller,et al.  Letter: Acute oliguric glomerulonephritis. , 1975, Lancet.

[16]  D. Miller,et al.  EXERCISE AND DIETARY-INDUCED THERMOGENESIS , 1975, The Lancet.

[17]  S. Finklestein.  Neurological Syndromes After Cardiac Arrest , 1978, Stroke.

[18]  M. Mcnicol,et al.  SURVIVAL AFTER CARDIAC ARREST IN HOSPITAL , 1977, The Lancet.

[19]  J. Ruskin,et al.  Out-of-hospital cardiac arrest: electrophysiologic observations and selection of long-term antiarrhythmic therapy. , 1980, The New England journal of medicine.

[20]  Neurologic prognosis after cardiopulmonary arrest: II. level of consciousness , 1980 .

[21]  R. Scott.  Cardiopulmonary resuscitation in a teaching hospital , 1981, Anaesthesia.

[22]  M. DeBard,et al.  Cardiopulmonary resuscitation: analysis of six years' experience and review of the literature. , 1981, Annals of emergency medicine.

[23]  Linda Fisher,et al.  WHY OUTCOME OF CARDIOPULMONARY RESUSCITATION IN GENERAL WARDS IS POOR , 1982, The Lancet.

[24]  P. Diehr,et al.  Prediction of awakening after out-of-hospital cardiac arrest. , 1983, The New England journal of medicine.

[25]  M. Copass,et al.  Neurologic recovery after out-of-hospital cardiac arrest. , 1983, Annals of internal medicine.

[26]  E. Cook,et al.  Survival after Cardiopulmonary Resuscitation in the Hospital , 1983 .

[27]  F. Plum,et al.  Predicting outcome from hypoxic-ischemic coma. , 1985, JAMA.

[28]  Predicting outcome from hypoxic-ischemic coma. , 1985, JAMA.

[29]  Prognostic factors in cardiac arrest occurring in a district general hospital. , 1986, The British journal of clinical practice.

[30]  Prognostic factors in cardiac arrest occurring in a district general hospital. , 1986 .

[31]  M. Charlson,et al.  Medical patients at high risk for catastrophic deterioration. , 1987, Critical care medicine.

[32]  M. Urberg,et al.  Survival after cardiopulmonary resuscitation for an in-hospital cardiac arrest. , 1987, The Journal of family practice.

[33]  M. Moskowitz,et al.  Discharge decision-making in a medical intensive care unit. Identifying patients at high risk of unexpected death or unit readmission. , 1988, The American journal of medicine.