Clinical Antecedents to In-Hospital Cardiopulmonary Arrest

University of Miami, كورال غيبلز، فلوريدا, Florida, United States
Chest (Impact Factor: 7.48). 01/1991; 98(6):1388-92. DOI: 10.1378/chest.98.6.1388
Source: PubMed


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.

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    • "Providing an effective safety net for patients in general hospital wards involves the surveillance and timely or appropriate management of patients whose conditions may vary from stable to acutely unwell. The onset of critical illness appears to be often predictable (Schein et al. 1990). More effective rescue at an earlier stage is likely to lead to both health and economic gains by reducing cardiac arrests, intensive care unit (ICU) admissions and mortality rates (Buist et al. 1999, Hodgetts et al. 2002). "
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    • "Therefore, we hypothesize that the ICU nurses' perspective is currently overshadowing the ACU nurses' one in the literature . This might be explained by the origin of the interest in this issue, which was raised by studies conducted by medical researchers of patient trajectory prior to ICU admission or cardiac arrest (Schein et al., 1990; Goldhill et al., 1999; Hodgetts et al., 2002). Questioning the quality of care of deteriorating patients on ACU seems to have brought the focus solely on this environment . "
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