title: Acute Respiratory Compromise in the Emergency Department: A Description and Analysis of 3571 Events from the Get With the Guidelines-Resuscitation®Registry.
abstract: BACKGROUND
  Respiratory events requiring the use of assisted ventilation are relatively common in the emergency department (ED), and can be associated with substantial morbidity and mortality.
  
  
  OBJECTIVE
  The aim of this study was to describe and elucidate patient and event characteristics associated with mortality and progression to cardiac arrest in ED patients with acute respiratory compromise.
  
  
  METHODS
  Data were obtained from the multicenter Get With the Guidelines-Resuscitation® registry. We included patients with acute respiratory compromise defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation. All adult patients between January 2005 and December 2014 with an index event in the ED were included. We used multivariable logistic regression models to assess the association between patient and event characteristics and in-hospital mortality, with cardiac arrest during the event as a secondary outcome.
  
  
  RESULTS
  A total of 3571 events were included. The in-hospital mortality was 34%. Twelve percent of events progressed to cardiac arrest, with a subsequent 82% in-hospital mortality. When adjusting for patient and event characteristics, we found no temporal changes in in-hospital mortality from 2005 to 2014. Several characteristics were associated with increased mortality, such as pre-event hypotension, septicemia, and acute stroke. Similarly, multiple characteristics, including pre-event hypotension, were associated with progression to cardiac arrest.
  
  
  CONCLUSIONS
  Patient with acute respiratory compromise in the ED had an in-hospital mortality of 34% in the current study. These patients also have a high risk of progressing to cardiac arrest, with a subsequent increase in in-hospital mortality to 82%. Potentially reversible characteristics, such as hypotension before the event, showed a strong association to in-hospital mortality, along with multiple other patient and event characteristics.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Carl Mathias
authors.initials: CM
authors.lastname: Karlsson
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Massachusetts.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries / Q000706:statistics & numerical data; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality; D012143:Respiratory Physiological Phenomena; D018805:Sepsis / Q000401:mortality; D020521:Stroke / Q000401:mortality; D014481:United States
keywords: acute respiratory compromise; cardiac arrest; emergency department; intubation; outcomes