Continuous electrocardiographic monitoring and cardiac arrest outcomes in 8,932 telemetry ward patients.
OBJECTIVE
To estimate the benefit of routine electrocardiographic (ECG) telemetry monitoring on in-hospital cardiac arrest survival.


METHODS
In a tertiary care hospital, all telemetry ward admissions and cardiac arrests occurring over a five-year period were reviewed. Ward location and survival to discharge were determined for all patients outside of critical care areas.


RESULTS
During the study period, 8,932 patients were admitted to the telemetry ward, and 20 suffered cardiac arrest (0.2%; 95% CI = 0.1 to 0.3). Telemetry monitors signaled the onset of cardiac arrest in only 56% (95% CI = 30 to 80) of monitored arrests. Three patients survived to discharge, and in two of these three patients the arrest onset was signaled by the monitor. This yields a monitor-signaled survival rate among telemetry ward patients of 0.02% (95% CI = 0 to 0.05). All survivors suffered significant arrhythmias prior to their cardiac arrests.


CONCLUSIONS
Cardiac arrest is an uncommon event among telemetry ward patients, and monitor-signaled survivors are extremely rare. Routine telemetry offers little cardiac arrest survival benefit to most monitored patients, and a more selective policy for telemetry use might safely avoid ECG monitoring for many patients.
Schull
M J
MJ
Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada. mjs@ices.on.ca
Redelmeier
D A
DA
D000368:Aged; D016001:Confidence Intervals; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000706:statistics & numerical data; D009864:Ontario; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013686:Telemetry / Q000379:methods / Q000706:statistics & numerical data*