Chest
Volume 98, Issue 6, December 1990, Pages 1388-1392
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Clinical Investigations
Clinical Antecedents to In-Hospital Cardiopulmonary Arrest

https://doi.org/10.1378/chest.98.6.1388Get rights and content

While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161±26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29±1 breaths per minute. The prognoses of patients’ underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.

Section snippets

Methods

Over a four-month period (July through October 1987), patients developing arrest on the general inpatient services of the Jackson Memorial Hospital Medical Center, a 1,200-bed University-affiliated county and tertiary care facility, were studied. Patients were identified by daily interviews of the hospital's cardiac arrest team physicians and daily monitoring of all patients admitted to intensive care units or placed on ventilators. Patients developing arrest in the operating or recovery rooms,

Results

Sixty-four patients were identified as having cardiopulmonary arrest during the study period. Of these, 59 (92 percent) had cessation of both respiratory and cardiac function while five (8 percent) had respiratory arrest alone. The mean age of patients was 51±2 years. Forty-four patients (69 percent) were male. Arrest occurred a mean of 161±26 hours (range, 4 to 1,026 hours) after hospital admission. Fifty-seven arrests occurred on the general and subspecialty Internal Medicine and Family

Discussion

We have studied a group of patients who had cardiopulmonary arrest on the general ward services with an emphasis on events preceding arrest. The classification of the underlying pathophysiologic abnormalities was determined conservatively by the use of definitions requiring significant and progressive derangements. Despite this, only six patients failed to meet criteria for one of the diagnostic categories and 18 met criteria for more than one category. The most common abnormalities were those

ACKNOWLEDGMENTS

The authors are indebted to the nursing, respiratory therapy, and house staffs of Jackson Memorial Hospital for their assistance and to Janis W. Kampka for her technical assistance.

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    Presented in part at the 17th Annual Society of Critical Care Medicines Educational and Scientific Symposium, May 1988, and published in abstract form in Crit Care Med 1988; 16:385.

    Manuscript received November 22, 1989; revision accepted May 21.

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