title: Clinical outcomes of witnessed and monitored cases of in-hospital cardiac arrest in the general ward of a university hospital in Korea.
abstract: BACKGROUND
  There are few studies of the epidemiology and clinical outcomes of patients with in-hospital cardiac arrest (IHCA) in a general hospital ward.
  
  
  OBJECTIVE
  To investigate the clinical outcomes of IHCA cases that occurred in the general ward of a university hospital and that were witnessed and/or monitored.
  
  
  METHODS
  We prospectively gathered data on all IHCAs in the general ward of Asan Medical Center, Seoul, South Korea, that were recorded by the Medical Emergency Team between March 2008 and February 2010. The main outcomes included survival to hospital discharge, incidence of IHCA, and prognostic factors related to hospital mortality. We also investigated preventable cases.
  
  
  RESULTS
  We identified 238 index cases of IHCA. The average incidence of IHCA was 0.145 IHCAs per 1,000 patient admissions. Survival to hospital discharge was 19% (46 cases), 66% of which were due to non-cardiac causes, and 77% were due to medical illnesses. The most common first documented rhythm was pulseless electrical activity (38%). Two hundred three cases (85.3%) of IHCA were witnessed at the event; 135 cases (56.7%) were monitored at the event. Non-witnessed cases, monitored cases, night onset, medical illness, metastatic cancer, intubation, and long duration of cardiopulmonary resuscitation were significantly associated with hospital mortality. We identified 91 preventable cases (38%). Respiratory insufficiency (37 cases, 41%) was one of major cause of preventable IHCA.
  
  
  CONCLUSIONS
  Witnessed IHCAs in the general ward had a higher rate of survival to hospital discharge; however, monitored cases had a lower rate of survival to hospital discharge. Respiratory insufficiency was a major preventable cause of IHCA. In consideration of the preventable IHCAs, further studies should be performed on monitoring practices in general wards.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chungju Hospital, School of Medicine, Konkuk University, Chungju, Chungcheongbuk-do, Korea.
authors.forename: Gyu Rak
authors.initials: GR
authors.lastname: Chon
authors.forename: Jinmi
authors.initials: J
authors.lastname: Lee
authors.forename: Yujung
authors.initials: Y
authors.lastname: Shin
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005104:Expert Testimony / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010351:Patient Discharge / Q000639:trends; D010362:Patients' Rooms; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D013997:Time Factors
keywords: general ward; hospital mortality; in-hospital cardiac arrest; monitoring; witnessed