In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response.
OBJECTIVE
To evaluate the factors affecting the outcome of in-hospital cardiac arrest.


METHODS
A 1400-bed tertiary care teaching hospital with a dedicated cardiac arrest team (CAT). The CAT was immediately available in monitored areas (intensive care unit and emergency room). In the wards the staff had only BLS skills and automated external defibrillation was not available.


METHODS
A 2-year prospective audit according to the Utstein style.


RESULTS
A total of 114 cardiac arrests (37 with VF/VT and 77 with non-VF/VT) were included. Fifty-two cardiac arrests (46%) occurred in monitored areas, 62 (54%) occurred in non-monitored areas. The CAT arrival time in non-monitored areas was 3.98+/-1.73 min. Thirty-seven patients (32%) survived to hospital discharge. Cardiac arrests occurring in monitored areas had a significantly better outcome than those occurring in the wards. Patient survival in the wards was significantly higher when the CAT arrival time was less than 3 min. No patient whose CAT arrival time was longer than 6 min survived. CAT arrival time was significantly shorter (1.30+/-1.70) in survivors than in non-survivors (2.51+/-2.37; P<0.005). Sex, age and presence of bystanders were not significantly associated with survival.


CONCLUSIONS
In our setting, where bystander defibrillation was not available, the survival of patients having cardiac arrest in non-monitored areas strongly depends on advanced life support provided by the CAT. A faster CAT response and early defibrillation from the ward staff are the most important improvements necessary to increase cardiac arrest survival in our setting.
Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Gemelli 8, 00168 Rome, Italy.
Claudio
C
Sandroni
Giorgia
G
Ferro
Susanna
S
Santangelo
Francesca
F
Tortora
Lorenza
L
Mistura
Fabio
F
Cavallaro
Anselmo
A
Caricato
Massimo
M
Antonelli
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome