Anticipating events of in-hospital cardiac arrest.
OBJECTIVE
To determine whether in-hospital cardiac arrests occurring in regular wards are preceded by some event(s), and the diagnostic and therapeutic measures adopted.


METHODS
From 1 May 1999 to 31 December 2001, events occurring in the 6 h preceding cardiac arrest were reviewed by checking the medical and nurse records and interviewing the attending staff. Exclusion criteria were (a) location in the Coronary Care Unit, the Intensive Care Unit, the Emergency Department and the operating rooms; (b) the presence of rapidly fatal disease; (c) the lack of adequate documentation.


RESULTS
Overall, 263 cardiac arrests occurred in the period under consideration. A total of 148 patients (61 women, 87 men, aged 74.3+/-1.2 years) fulfilled the entry criteria. Anticipating events were reported in 128 patients (86.4%). These included alterations in consciousness, cardiac arrhythmias, dyspnoea and chest pain. The restoration of cardiac rhythm was obtained in 23 patients (15.5%). Eight (5.4%) survived without major neurological sequelae. Survivors were significantly younger than non-survivors (survivors 44.3+/-6.8 years; non-survivors 76.7+/-2.1 years; P<0.005). In a substantial number of cases, ranging from 23 to 81%, according to the anticipating event, no diagnostic investigations were performed.


CONCLUSIONS
Most in-hospital cardiac arrests are preceded by events that often go overlooked and whose correct interpretation could be associated with a reduced mortality rate.
Berlot
Giorgio
G
Department of Anaesthesia and Intensive Care, University of Trieste, Trieste, Italy. berlot@inwind.it
Pangher
Annamaria
A
Petrucci
Lara
L
Bussani
Rossana
R
Lucangelo
Umberto
U
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis