In-hospital cardiac arrest: can we change something?

Herzstillstand im Spital: Können wir etwas ändern?

Summary

Cardiac arrest is classified as ‘in-hospital’ if it occurs in a hospitalised patient who had a pulse at the time of admission. A probability of patient’s survival until hospital discharge is very low. The reasons for this are old age, multiple co-morbidity of patients, late recognition of cardiac arrest, poor knowledge about basic life support algorithm, insufficient equipment, absence of qualified resuscitation teams (RTs) and poor organization.

The aim of this study was to demonstrate characteristics of in-hospital cardiac arrests and resuscitation measures in University Hospital Osijek. We analysed retrospectively all resuscitation procedures data where anaesthesiology RTs provided cardiopulmonary resuscitation (CPR) during 5-year period.

We analysed 309 in-hospital resuscitation attempts with complete documentation. Victims of cardiac arrest were principally elderly patients, neurological (30.4 %), surgical (25.24 %) and neurosurgical patients (15.2 %) with many associated severe diseases. In 85.6 % of the cases, resuscitation was initiated by ward personnel and RTs arrived within 5 min in 67 % of the cases. However, in 14.6 % of the cases resuscitation measures had not been started before RT arrival. We found statistical correlation between lower initial survival rates and length of hospital stay (p = 0.001), presence of cerebral ischemia (p = 0.026) or cardiomyopathy (p = 0.004) and duration of CPR (p = 0.041). Initial survival was very low (14.6 %), and full recovery was accomplished in only eight patients out of 309 (2.59 %).

Identification of terminal chronic patients in which the CPR is not reasonable, a better organisation and ward personnel education can contribute to better overall success.

Zusammenfassung

Herzstillstand wird als „in-hospital“ definiert, wenn er bei einem hospitalisierten Patienten auftritt, der einen Puls zum Zeitpunkt der Aufnahme hatte. Die Wahrscheinlichkeit des Überlebens des Patienten bis zur Entlassung aus dem Spital ist sehr niedrig. Die Gründe dafür sind hohes Alter, multiple Komorbiditäten, spätes Erkennen des Herzstillstands, schlechte Reanimationskenntnisse, mangelhafte Ausrüstung, Abwesenheit von qualifizierten Wiederbelebungsteams und schlechte Organisation.

Ziel der Studie war es, die Charakteristika von „in-hospital“ Herzstillständen und der entsprechenden Wiederbelebungsmaßnahmen im Universitätsspital Osijek aufzuzeigen. Wir analysierten retrospektiv alle Wiederbelebungsprozeduren eines 5-Jahreszeitraums, bei denen Anästhesisten-Reanimationsteams kardiopulmonale Wiederbelebung versuchten. Wir analysierten 309 komplett dokumentierte „in-hospital“ Reanimationsversuche.

Opfer eines Herzstillstandes waren im Prinzip ältere Patienten, 30,4 % neurologische, 25,24 % chirurgische und 15,2 % neurochirurgische Patienten mit vielen schweren Begleiterkrankungen. Bei 85,6 % der Fälle wurde die Wiederbelebung durch das Stationspersonal begonnen. Die Reanimationsteams erschienen innerhalb von 5 Minuten in 67 % der Ereignisse. Allerdings wurde in 14,6 % der Fälle mit der Reanimation erst nach Eintreffen des Reanimationsteams begonnen. Wir fanden einen statistisch signifikanten Zusammenhang zwischen einer niedrigeren initialen Überlebensrate und der Dauer des stationären Aufenthaltes (p = 0,001), dem Vorliegen einer cerebralen Ischämie (p = 0,026) oder einer Kardiomyopathie (p = 0,004) und der Dauer der kardiopulmonalen Reanimation (p = 0,0041). Die initiale Überlebensrate war sehr niedrig (14,6 %). Eine komplette Erholung trat nur bei 8 von 309 Patienten (2,59 %) ein.

Eine Identifizierung von terminal chronisch kranken Patienten, bei denen eine kardiopulmonale Reanimation nicht sinnvoll ist, scheint nicht vernünftig. Eine bessere Organisation und eine Schulung des Stationspersonals kann zu einem besseren Gesamterfolg beitragen.

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The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Correspondence to Tomislav Ružman.

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Ružman, T., Tot, O., Ivić, D. et al. In-hospital cardiac arrest: can we change something?. Wien Klin Wochenschr 125, 516–523 (2013). https://doi.org/10.1007/s00508-013-0409-0

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Keywords

  • In-hospital cardiac arrest
  • Cardiopulmonary resuscitation
  • Resuscitation team
  • Survival

Schlüsselwörter

  • Herzstillstand („in hospital“)
  • Kardiopulmonale Reanimation
  • Reanimationsteam
  • Überleben