Clinical outcomes of patients with in-hospital witnessed cardiac arrest: effect of co-morbidities

Abstract

Abstract Introduction Cardiopulmonary resuscitation (CPR) is frequently performed in hospitalized patients after in-hospital cardiac arrest (IHCA), especially in the intensive care unit (ICU) (J Crit Care 24:408-414, 2009). Despite the fact that nearly half of the in-hospital cardiac arrests (IHCA) actually happen in intensive care units (ICUs) (N Engl J Med 367:1912-1920, 2012), intensive care unit cardiac arrest (ICU-CA) compared to IHCA or out-of-hospital cardiac arrests (OHCA) has received little attention, and data on ICU-CA remains scanty (Intensive Care Med 40:1853-1916, 2014). Aim We aimed to evaluate the clinical status and factors associated with the survival of patients subjected to cardiopulmonary resuscitation (CPR) after a witnessed cardiac arrest (CA) inside the medical intensive care unit (MICU). Patients The study included 110 patients, mean age of 60 ± 18 years, 69 (63%) males, and 41 (37%) females. Co-morbidities included diabetes mellitus was present in 46 (42%), hypertension 57 (52%), central nervous system (CNS) disease 31 (29%), cardiovascular (CVS) 76 (69%), respiratory 63 (57%), hepatic 16 (15%), shock 35 (32%), and renal 44 (40%). Mechanical ventilation was present in 97 (88%) of patients. SOFA score < 9 was present in 38%, MPM III score < 10 in 37%, and GCS > 7 in 66% of patients. Non-shockable rhythm occurred in 95 (86%) while shockable rhythm in 15 (14%) of patients. Methods Data were collected prospectively at the medical ICU of Cairo University from Jan. 2013 to Feb 2013. A resuscitation protocol was done according to the latest recommendation of the European Society of Cardiology at the time of patient inclusion. Clinical data were recorded and surviving patients were clinically followed daily until hospital discharge. Results Out of 110 witnessed cardiac arrests, CPR was initially successfully manifested by return of spontaneous circulation (ROSC) in 60 patients (55%), of whom 22 (20%) survived hospital discharge and only 9 patients (8%) were functionally independent. Compared to non-survivors, 60 patients (55%) with ROSC had a MPM III < 10 (p 0.015), EF ≥ 50% (p 0.001), and non-shocked patients (p 0.008). Other factors such as DC shocks < 3 (p 0.02), CPR cycles < 2 (p < 0.001), resuscitation duration < 10 min (p 0.03), time to start CPR < 1 min (p 0.001), maintained HCO3 (p 0.03), and PaCO2 (p 0.002) were found to improve ROSC. Mortality before discharge decreased with asystole (p < 0.01). Mortality before discharge increased with CNS (p < 0.02) and respiratory comorbidities (p 0.02), shock (p < 0.001) and mechanical ventilation (p < 0.0001), SOFA > 9 (p 0.001), MPM III > 10 (0.018), and time to start CPR > 1 min (p 0.001). Conclusion Not all ROSC reached long-term survival and hospital discharge. Several co-morbidities affect ROSC and short-term and long-term patient survival after witnessed MICU cardiac arrest.