Journal of Acute Disease (Jan 2019)

Survival to discharge after in-hospital cardiac arrest at emergency department and its associated factors: a prospective observational study

  • Surendar Ravipragasam,
  • Deepika Chandar,
  • Vinay R Pandit,
  • Anusha Cheriyan

DOI
https://doi.org/10.4103/2221-6189.268406
Journal volume & issue
Vol. 8, no. 5
pp. 185 – 190

Abstract

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Objectives: To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital, South India. Methods: This prospective observational study was conducted between December 2016 and May 2017 among all patients above 12 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: The study cohort contained 252 participants. The age was (50.0+17.2) years and male patients accounted for 54.4%. The most common complaint was breathlessness (29%), followed by chest pain (20.2%) and trauma (17.5%). The proportion of non-shockable rhythm (77.4 %) was higher than shockable rhythm (22.6%). Pulseless electrical activity (53.9%) was the most common initially documented rhythm. The predominant presumed cause of arrest was cardiac origin (29.7%). The overall rate of survival to discharge was 17.5%. Logistic regression analysis showed age >60 years [odds ratio (OR): 3.4, 95% confidence interval (CI): 1.03-11.22, P=0.04], males (OR: 3.45, 95% CI: 1.00-11.44; P=0.04), presumed respiratory cause (OR: 11.8, 95% CI: 1.0-160.0, P=0.05), initial rhythm ventricular fibrillation (OR: 9.1, 95% CI: 1.0-92.0, P=0.05) as individual predictors of survival rate to discharge after in-hospital cardiac arrest. Conclusions: Our study shows that less than one-fifth of patients survive to discharge after inhospital cardiac arrest. This signifies the need to identify and to make the necessary changes at all levels of organization, service delivery and patient care, so as to improve the overall survival rate following cardiac arrest.

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