Characterization of cardiac arrest in the emergency department of a Brazilian University Reference Hospital: A prospective study
Cassia Regina Vancini-Campanharo1, Rodrigo Luiz Vancini2, Claudio Andre Barbosa de Lira3, Marília dos Santos Andrade4, Maria Carolina Barbosa Teixeira Lopes1, Meiry Fernanda Pinto Okuno1, Ruth Ester Assayag Batista1, Álvaro Nagib Atallah5, Aécio Flávio Teixeira de Góis5
1 Paulista School of Nursing/Federal University of Sao Paulo, 754 Napoleao de Barros Street, São Paulo, SP 04024-002, Brazil
2 Federal University of Espirito Santo, 173 Feliciano Bicudo Street, Sao Paulo, SP 02301-020, Brazil
3 Federal University of Goias, Goiania, GO 74001-970, Brazil
4 Federal University of Sao Paulo, 862 Botucatu Street, Sao Paulo, SP 04023-062, Brazil
5 Paulista School of Medicine/ Federal University of Sao Paulo, 740 Botucatu Street, Sao Paulo, SP 04023-062, Brazil
Cassia Regina Vancini-Campanharo
Escola Paulista de Enfermagem/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 754, 2° andar, Vila Clementino, 04024-002 São Paulo, SP
Source of Support: None, Conflict of Interest: None
Background & objectives: Sudden cardiac arrest (CA) represents one of the greatest challenges for medicine due to the vast number of cases and its social and economic impact. Despite advances in cardiopulmonary resuscitation (CPR) techniques, mortality rates have not significantly decreased over decades. This study was undertaken to characterize patients that have suffered CA and to identify factors related to mortality.
Methods: This prospective study was conducted at Emergency Department of São Paulo Hospital, Brazil. Two hundred and eighty five patients were followed for one year after treatment for CA. The mean age was 66.3±17.2 yr, and they were predominantly male (55.8%) and Caucasian (71.9%). Mortality rate and factors associated with mortality were the primary and secondary outcome measures. Data were collected using an in-hospital Utstein-style report. A logistic regression analysis was used to determine which variables were related to mortality.
Results: Regarding the characteristics of CPR, 76.5 per cent occurred in hospital, respiratory failure was the most common presumed immediate cause of CA (30.8%) and pulseless electrical activity was the most frequent initial rhythm (58.7%). All attempts at CPR utilized chest compressions and ventilation and the most utilized interventions were epinephrine (97.2%) and intubation (68.5%). Of all patients treated, 95.4 per cent died. Patients with pulseless electrical activity had a higher risk of death than those patients with ventricular fibrillation.
Interpretation & conclusions: The findings of the study highlighted that the mortality rate among CA patients was high. The variable that best explained mortality was the initial CA rhythm.