Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit.
BACKGROUND
There is a paucity of data on patient outcomes following in-hospital cardiac arrest (IHCA) on the Internal Medicine clinical teaching unit (CTU). Accurate outcome data enhances discussions between patients, surrogates, and physicians, and assists in their management.


METHODS
We performed a retrospective cohort study of consecutive "Code Blue" calls on 2 medical CTUs in a Canadian tertiary centre from January 1, 2003 to June 30, 2007. The medical records of identified patients were screened for eligibility and patient-specific and arrest-specific data were collected for eligible events. Primary outcome was survival to hospital discharge.


RESULTS
Our cohort comprised 83 patients; including 54 (65.1%) men with a mean age of 75 years (range, 38-97). Infection (34.9%) was the principal reason for admission and over half of patients had 3 or more comorbid illnesses. Forty-three (51.8%) of the IHCA events were witnessed. In all, 39 (90.7%) of the witnessed and 36 (90%) of the unwitnessed arrests were pulseless electrical activity (PEA) or asystole (P = not significant). Return of spontaneous circulation occurred in 29 patients (34.9%) and 2 (2.4%) survived to hospital discharge. No patients survived to discharge after unwitnessed arrest.


CONCLUSIONS
IHCA in Internal Medicine CTU patients is characterized by a high rate of PEA/asystole and a minimal chance of survival to hospital discharge. Moreover, no patient with an unwitnessed arrest survived to hospital discharge. While these findings require confirmation in a larger study, they merit consideration in the context of code status discussions, particularly with respect to the response to unwitnessed arrests.
Division of General Internal Medicine, McGill University, Montreal, Québec, Canada. b.schwartz@sympatico.ca
Blair C
BC
Schwartz
Dev
D
Jayaraman
Paul J
PJ
Warshawsky
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends