Publications (2)5 Total impact
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Article: Correlations between first documented cardiac rhythms and preceding telemetry in patients with code blue events.
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ABSTRACT: BACKGROUND: Among in-hospital cardiac arrest (IHCA) patients, the first cardiac rhythm documented on resuscitation records (FDR) is often used as a surrogate for arrest etiology. Although the FDR generally represents the electrical activity at the time of cardiopulmonary resuscitation initiation, it may not be the ideal rhythm to infer the arrest etiology. We hypothesized that a rhythm present earlier-at the time of the code blue call-would frequently differ from the FDR, because the FDR might represent the later stage of a progressive cardiopulmonary process. OBJECTIVE: To evaluate agreement between FDR and telemetry rhythm at the time of code blue call. DESIGN: Cross-sectional study. SETTING: A 750-bed adult tertiary care hospital and a 240-bed adult inner city community hospital. PATIENTS: Adult general ward patients monitored on the hospital's telemetry system during the 2 minutes prior to a code blue call for IHCA. INTERVENTION: None. MEASUREMENTS: Agreement between FDR and telemetry rhythm. RESULTS: Among 69 IHCAs, agreement between FDR and telemetry was 65% (kappa = 0.37). Among 17 events with FDRs of ventricular tachyarrhythmia (VTA), telemetry showed VTA in 12 (71%) and other organized rhythms in 5 (29%). Among 12 events with first documented rhythms of asystole, telemetry showed asystole in 3 (25%), VTA in 1 (8%), and other organized rhythms in 8 (67%). CONCLUSIONS: The FDR had only fair agreement with the telemetry rhythm at the time of code blue call. The telemetry rhythm may be a useful adjunct to the FDR when investigating arrest etiology. Journal of Hospital Medicine 2013;8:000-000. © 2013 Society of Hospital Medicine.Journal of Hospital Medicine 03/2013; · 1.40 Impact Factor -
Article: Antecedent bradycardia and in-hospital cardiopulmonary arrest mortality in telemetry-monitored patients outside the ICU.
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ABSTRACT: Patients with in-hospital cardiopulmonary arrest (IHCA) precipitated by respiratory insufficiency often exhibit bradycardia before the arrest. We hypothesized that bradycardia frequently occurs in the 10 min preceding IHCA and is associated with poor outcomes when IHCA occurs outside the intensive care unit (ICU). To determine the prevalence and association of antecedent bradycardia with outcome in adult patients with IHCA occurring outside the ICU. We performed a retrospective cohort study among telemetry monitored adults with IHCA outside the ICU in a two-hospital health system between 2008 and 2010 with follow-up until their discharge or death in-hospital. We defined (1) IHCA as >1 min of chest compressions or trans-thoracic defibrillation, (2) Antecedent bradycardia as at least 2 min of continuous heart rate between 1 and 59 beats per minute in the 10min preceding IHCA, and (3) ventricular tachyarrhythmia arrests as presence of sustained ventricular tachyarrhythmia for >20 s in the 10 min preceding IHCA. Of 98 IHCAs, 39 (39.8%) survived to hospital discharge. Of 98 IHCAs, 53 (54.1%) had antecedent bradycardia. After adjusting for potential confounders, antecedent bradycardia was associated with death prior to hospital discharge (adjusted OR=3.80, 95% CI: 1.47-9.81, p=0.006). Among patients with ventricular tachyarrhythmia arrests, antecedent bradycardia was associated with a higher risk of death (OR=13.1, 95% CI 1.92-89.5, p=0.009). Antecedent bradycardia occurred frequently and was associated with death prior to hospital discharge in non-ICU hospitalized adults on telemetry monitoring who developed IHCA.Resuscitation 03/2012; 83(9):1106-10. · 3.60 Impact Factor
