Cardiac Arrest in the Critically Ill

Abstract

The events preceding cardiac arrest were investigated in 132 critically ill patients on the basis of the hemodynamic, respiratory, and metabolic status prior to cardiac arrest. Approximately one-half of the patients had respiratory acidosis prior to cardiac arrest and only one of these patients ultimately survived. An additional one-fourth had metabolic acidosis due to progressive perfusion failure (shock), and none survived. In the remaining one-fourth, an immediate catastrophic and potentially preventable event accounted for cardiac arrest, and all but one of the long-term survivors were included in this group. In thirteen patients, obstruction or dislodgment of endotracheal tracheostomy tubes, or interruption of ventilation, was recognized as the immediate cause. In an additional 20 patients, cardiac arrest was associated with an adverse effect of a drug. Twelve instances of cardiac arrest were associated with central venous injection of aminophylline. The initial cardiac resuscitation attempt was effective in 38% of patients. However, the majority of patients who survived the first episode succumbed after a second or third episode. The cumulative survival was disappointingly small. Only six patients, or 5% of the total group of 132 patients, were long-term survivors. These data may provide the basis for more restricted use of routine and repetitive resuscitative measures particularly for elderly patients in whom acidemia is due to progressive ventilatory or circulatory failure.