Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey

doi:10.1016/S0300-9572(98)00056-2

Resuscitation

Volume 37, Issue 3, June 1998, Pages 133-137

https://doi.org/10.1016/S0300-9572(98)00056-2 Get rights and content

Abstract

The hospital cardiac arrest team is summoned in response to a sudden severe deterioration in a patient's condition. However, clinical experience suggests that some calls to general wards are preceded by a more gradual, possibly treatable decline. We undertook this study to define the extent of the problem and look for features that might enable prediction and prevention of cardiorespiratory arrest. We identified patients on general medical and surgical wards for whom cardiac arrest calls had been made. Their casenotes were examined for documentation of abnormal physical signs and laboratory test results in the 24 h before the call. We noted what doctors and nurses had done after abnormalities had been found. Over a 28-week period, calls were made for 47 patients on these wards. Twenty-four (51%) had premonitory signs. These patients were also less likely to survive to hospital discharge (P=0.02). We conclude that some cardiorespiratory arrests are predictable. Wider appreciation of the significance of abnormal signs and laboratory test results could lead to prompter involvement of experienced clinicians and more aggressive therapy. Alternatively, as mortality is so high in this group of patients, more patients could be appropriately designated `not for resuscitation'.

Introduction

It is now standard practice for hospitals to have a `cardiac arrest' team to respond rapidly to sudden medical emergencies. Although the event which triggers a cardiac arrest call is sudden, subjective experience suggests that some arrests are preceded by a more gradual deterioration. Treatment is more likely to be beneficial if it is started before, rather than after the arrest. We aimed to undertake a survey of cardiopulmonary arrests in areas of the hospital where patients are not under close observation with electronic monitoring, to find out whether arrest calls could be predicted and possibly prevented.

Section snippets

Method

Over a 28-week period, we conducted a survey of cardio-respiratory arrests on the medical and surgical wards of a 625-bedded teaching hospital. The date, time and location of each cardiac arrest call were obtained from the hospital switchboard. Calls put out for a single member of staff were excluded, as were calls to all hospital areas other than the medical/geriatric and surgical wards. One of us visited the wards within 72 h of the arrest to identify the patient concerned; the patient's

Results

During the study period, 98 cardiac arrest calls were made by the hospital switchboard.

Fifty-one of these were excluded from analysis (Table 2Table 3). In six cases, the patient for whom the call had been made was not identified on visiting the ward; one further patient was identified, but his hospital notes could not be found for analysis. The remainder were excluded because of location within the hospital or clinical circumstances. Multiple arrest calls were made for two patients (two calls

Discussion

This study has two main findings. Firstly, many patients for whom a cardiac arrest call is made on medical and surgical wards have abnormal vital signs and laboratory results for many hours before their condition worsens to the point where the call is made. Secondly, the results of resuscitation are very poor; only three of the 24 patients with abnormal vital signs could be resuscitated, and none survived to be discharged from hospital. We believe that many arrest calls need not, and perhaps

Acknowledgements

We would like to thank Kevin Bruce, Resuscitation Training Officer for the Central Manchester Healthcare Trust, and the Clinical Audit Department for their help in data collection. We are also grateful to Professor B. Pollard for his comments on the manuscript and Dr Benbow for providing post-mortem data.

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Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey

Abstract

Introduction

Section snippets

Method

Results

Discussion

Acknowledgements

Chest

Am J Med

Resuscitation

Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS study): methods and overall results

Br Med J