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Authors: Hanan Alhajri , Danish Muhammad Sami , Jean Jacques Du Plessis , Ayesha Almemari

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Abstract

Background: Cardiac arrest in the emergency department (ED) has not been well studied; however, the existing literature shows that there are better survival and neurological outcomes with cardiac arrest in the ED than out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrests. The aim of this study was to examine the cardiac arrests managed in a tertiary care center ED and identify the characteristics of patients who had good outcomes. Methods: This was a retrospective chart review of patients who had cardiac arrest in ED from January 2018 to June 2019 Results: There were 209 cardiac arrests reported in the ED. A total of 189 patients were excluded because they presented with OHCA. Twenty patients had cardiac arrests in the ED. The survival to discharge from the hospital for the total patients analyzed was 40% (8/20). 60% (12/20) of patients were male with a median age of 60.5 years. Altered mental status or drowsiness was the presenting complaints of nearly 40% (8/20) of the patients, followed by dyspnea in 20% (4/20). Only 10% (2/20) reported having chest pain at presentation. 45% (9/20) of the patients had peri-intubation arrest. The most common initial rhythm was pulseless electrical activity (PEA) (70%, 14/20), followed by asystole (25%, 5/20) and ventricular fibrillation (VF), which was only 5% (1/20). 95% (19/20) of the patients had a return of spontaneous circulation with an average duration of cardiopulmonary resuscitation (CPR) of only 5 minutes. CPR duration and heart rate (HR) on arrival were the potential predictors of survival as per the classification and regression trees method. Age, gender, HR as a continuous variable, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure >70 mm hg, the Modified Early Warning Score, or National Early Warning Score 2 were not statistically significant by Cox regression analysis as predictors of survival. Conclusion: Cardiac arrests occurring in ED are associated with better outcomes than OHCAs. CPR duration of less than 5 minutes coupled with presenting HR of > 110 b/min might be a predictor of survival. Larger database analyses of cardiac arrest in EDs are needed to validate this finding.

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Keywords: Out-of-hospital cardiac arrests, emergency department cardiac arrests, peri-intubation arrests, MEWS, NEWS2, pseudo-PEA

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