Outcome of Emergency Room Cardiopulmonary Resuscitation and Factors Associated with ROSC at Ramathibodi Hospital
Category:
Background:
There was a limitation to give characterization of in-hospital cardiac arrest (IHCA), especially intra-emergency department cardiac arrest (IEDCA). We aim to study the rate of successful cardiopulmonary resuscitation (CPR) and determine factors associated with time to sustained returned of spontaneous circulation (ROSC) in IEDCA.
Objective:
1.To study current rate of successful CPR initiated at emergency room, Ramathibodi Hospital.2.To study factors associated with time to sustained ROSC.
Method:
Retrospective cohort study of adults with IEDCA conducted at Ramathibodi Hospital emergency room between October 2012 and September 2015. Data were collected by medical records review. Rate of successful CPR was observed. Univariate and multivariate data analyses were used to identify factors related to time to sustained ROSC, survival to discharge, and neurological outcome.
Results:
Of 149 patients enrolled, there were 96 (64.43%), 80 (53.69%) and 21 (14.09%) patients who had sustained ROSC, survived to admission, and survived to discharge, respectively. Twenty patients (95.24%) were discharged with good cerebral performance. Median time to sustained ROSC was 27 minutes. Arrests at observation area had poorer prognosis (SHR 0.65 (95%CI: 0.42-1.02)) compared to resuscitation room. Pulseless electrical activity (PEA) (67.78%) was the most common initial cardiac rhythm and offered the best prognosis (SHR 0.43 (95%CI: 1.04-2.79)). Respiratory cause was a favorable prognostic factor (SHR 1.99 (95%CI: 1.12-3.54)). Initial PEA, arrests at resuscitation room, and respiratory cause were factors associated with time to sustained ROSC in univariate analysis, not in multivariate analysis.
Conclusion:
Most IEDCA resulted in sustained ROSC, but only one fifth was discharged with good cerebral performance. Median time to sustained ROSC was 2 7 minutes. Arrests at resuscitation room, PEA as initial rhythm, and respiratory cause were favorable prognostic factors of time to sustained ROSC. However, none represented association in multivariate analysis.