Abstract
Objective: Study the survival-to-hospital discharge rate for veterans who underwent Advanced Cardiac Life Support (ACLS) and reach a better understanding of the variables that infl uence their survival after cardiac arrest. To aid in developing strategies directed towards decreasing the risks related to the event.
Design: A retrospective record review of advanced resuscitative attempts during the period of January 1st to December 31st, 2006.
Setting: VA Caribbean Health Care System, San Juan.
Patients: Veterans admitted during the study period who suffered cardiac arrest.
Measurements: Patient’s age, sex, diagnosis, initial rhythm, location, time of event and duration of the resuscitation efforts (downtime), were collected.
Main results: There were 128 arrests documented during the study period: 122 (95%) were inhospital events and 6 involved patients brought to the emergency department during the course of resuscitation. The mean age was 72 years and 98% were males; most events occurred at general medical/surgical wards (61%). Events were mostly of cardiac origin (82.78%), with asystole (AS) and pulseless electrical activity (PEA) being he most common initial rhythms (61%). The most frequent pre-arrest diagnoses were sepsis, communityacquired pneumonia, renal failure and malignancy. Survival-to-hospital discharge was 7.38%; most survivors suffered primarily respiratory arrests while at the general wards. Arrest events were evenly distributed throughout the 24-hour day, and the average downtime in survivors was lower than in non-survivors (12 vs. 22.35 mins respectively, p=0.03).
Conclusions: We found a substantially lower survival rate for in-hospital cardiac arrests than has been previously reported. Possible explanations for this phenomenon include the high incidence of arrhythmias associated with poor outcome (AS, PEA), the frequency of unwitnessed events occurring in general wards, patient’s age and underlying diagnoses. Measures for the timely identifi cation of admitted patients who are at risk for poor resuscitative outcomes with these characteristics should be instituted.
Glorimar Santos-Llanos, Graciela Latalladi-Ortega, Ángel Galera-Santiago, Alfonso Torres-Palacios, William Rodríguez-Cintrón
