Predictors and outcomes of cardiac arrest in the emergency department of a university hospital in Turkey

Predictors and Outcomes of Cardiac Arrest in the Emergency Department of a University Hospital in Turkey Mehmet Erişen, Department of Emergency Medicine, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey. Introduction: Approximately 10% of all in-hospital cardiac arrests occur in the emergency department. Varying survival rates after cardiac arrest have been reported, and it is believed that patients who suffer cardiac arrest in the emergency department are thought to have higher survival rates. In this study, we aim to determine the incidence, demographic and clinical characteristics, outcomes, and factors affecting the outcomes of patients with cardiac arrest in the Adult Emergency Department of Dokuz Eylül University Hospital. Materials and Methods: Between 01/01/2018 and 12/31/2019, patients with spontaneous circulation and respiration at presentation to our emergency department that, later, went into cardiac arrest while still in the the emergency department were included in the study. Data of patients with cardiac arrest were accessed from electronic and written records. Data such as age, comorbidities, vital signs and treatments before cardiac arrest, CPR process data, and outcomes were recorded. The patients' mCCI scores were calculated. The relationships between the data and the outcome of CPR, the outcome at 24 hours, and the outcome at 30 days were analysed. Results: The study included 552 patients with cardiac arrest in the emergency department. Of these patients, 296 (53.6%) were male, with a median age of 79 (IQR: 68-86) and a mean age of 79 ± 14.13 years (range: 18-102). The median age of females (83 years, IQR: 73.3-89) was higher than that of males (73 years, IQR: 64-82). The most common complaint on admission to the emergency department was shortness of breath (35.1%). The median mCCI score was 6 in all patients, 7 in men and 6 in women. Most of the patients were managed in the Monitored Observation Unit (50.7%), and cardiac arrest occurred most frequently in a monitored unit (95.5%). The most common etiology for cardiac arrest was medical-noncardiac (73.6%). The medical-cardiac group accounted for 13% and the traumatic group for 3.8% of patients. More than half of the patients were on vasopressors, and more than half were receiving invasive mechanical ventilation when they suffered cardiac arrest. The median observation time to cardiac arrest in the emergency department was 11.8 hours, with 12.5% of patients experiencing cardiac arrest within the first hour of observation in the emergency department. The median duration of CPR was 20 minutes, and the median number of epinephrine administrations during CPR was 7. At the time of cardiac arrest, 7.7% of patients had a shockable rhythm, and 72 patients (13%) were defibrillated at some point during CPR. The median number of shocks in defibrillated patients was 2. The most common causes of cardiac arrest were pneumonia, septic shock, and malignancy. Of the 552 patients included in the study, 32.6% achieved sustained return of spontaneous circulation, 13.2% survived after 24 hours, and 4.7% survived after 30 days (3.1% were eventually discharged). Conclusion: Younger age, shorter CPR duration, and cardiac etiology were associated with higher survival in patients with cardiac arrest, whereas need for vasopressor support, longer CPR duration, older age, and noncardiac etiology were associated with lower survival. Keywords: emergency department, cardiopulmonary, arrest, resuscitation, mortality, modified Charlson comorbidity index