title: Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital.
abstract: OBJECTIVE
  Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. AIMS OF THE AUDIT: To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit.
  
  
  METHODS
  This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from 'code blue'. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations.
  
  
  RESULTS
  Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute.
  
  
  CONCLUSIONS
  A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval.
authors.affiliation: Department of Anaesthesia, Fortis Hospitals, Bengaluru, India. mailchakravarthy@gmail.com
authors.forename: Murali
authors.initials: M
authors.lastname: Chakravarthy
authors.forename: Sona
authors.initials: S
authors.lastname: Mitra
authors.forename: Latha
authors.initials: L
authors.lastname: Nonis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital / Q000592:standards; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D002983:Clinical Competence; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009873:Operating Rooms; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D062606:Tertiary Care Centers / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome