title: Clinical Characteristics and Mortality of Life-Threatening Events Requiring Cardiopulmonary Resuscitation in Gastrointestinal Endoscopy Units.
abstract: Little is known about life-threatening events during gastrointestinal endoscopy (GIE). This study aimed to evaluate the clinical characteristics of emergency conditions requiring cardiopulmonary resuscitation (CPR) in GIE units and to assess the risk factors for mortality in these cases.We retrospectively collected life-threatening cases that occurred in the GIE units of 6 tertiary hospitals from January 2012 to June 2014. Cases were defined as alert calls for resuscitation teams in emergency situations of respiratory failure or cardiac arrest. Demographic data, clinical features, and probable causes were assessed. Factors associated with mortality were elucidated using logistic regression analysis.Among 263,426 endoscopies, 40 cases of CPR (0.015%) occurred during the period (male 67.5%, median age 62 yr). Gastrointestinal bleeding (GIB), such as hematemesis or melena, was the most common indication for endoscopy (55%). The types of clinical situations encountered were as follows: respiratory insufficiency (47.5%), decreased blood pressure (25%), and cardiac arrhythmia (25%). Although most of these conditions were detected during endoscopy (67.5%), one-third of cases (32.5%) were found before or after procedures. The most frequent probable cause of cases was aggravation of underlying diseases (57.5%), such as uncontrolled bleeding or exacerbation of lung disease. Despite efforts to resuscitate, 18 patients (45%) died. GIB was the single independent risk factor for mortality (odds ratio 28.45, 95% confidence interval 1.55-523.33, P = 0.024).Life-threatening situations requiring CPR can occur during endoscopy, even before or after the procedure. Greater attention should be paid while endoscopy is performed for GIB.
authors.affiliation: From the Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine (HMP, ESK, SML, YJL, KSP, KBC); Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine (EYK, JTJ); Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine (KOK, BIJ); Division of Gastroenterology, Department of Internal Medicine, Fatima Hospital of Daegu (YJJ); Division of Gastroenterology, Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea (CHY); and Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea (HSL, SWJ).
authors.forename: Hye Min
authors.initials: HM
authors.lastname: Park
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kim
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Lee
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Park
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Jin Tae
authors.initials: JT
authors.lastname: Jung
authors.forename: Kyeong Ok
authors.initials: KO
authors.lastname: Kim
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Yun Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Chang Hun
authors.initials: CH
authors.lastname: Yang
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: Lee
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D016099:Endoscopy, Gastrointestinal / Q000401:mortality*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies