Clinical antecedents to in-hospital cardiopulmonary arrest

Roland Schein, N. Hazday, M. Pena, B. H. Ruben, C. L. Sprung

Research output: Contribution to journalArticle

507 Citations (Scopus)

Abstract

While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161±26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29±1 breaths per minute. The prognoses of patients' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.

Original languageEnglish
Pages (from-to)1388-1392
Number of pages5
JournalChest
Volume98
Issue number6
StatePublished - Dec 1 1990

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Heart Arrest
Patients' Rooms
General Hospitals
Vital Signs
Respiratory Rate
Nervous System
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Schein, R., Hazday, N., Pena, M., Ruben, B. H., & Sprung, C. L. (1990). Clinical antecedents to in-hospital cardiopulmonary arrest. Chest, 98(6), 1388-1392.

Clinical antecedents to in-hospital cardiopulmonary arrest. / Schein, Roland; Hazday, N.; Pena, M.; Ruben, B. H.; Sprung, C. L.

In: Chest, Vol. 98, No. 6, 01.12.1990, p. 1388-1392.

Research output: Contribution to journalArticle

Schein, R, Hazday, N, Pena, M, Ruben, BH & Sprung, CL 1990, 'Clinical antecedents to in-hospital cardiopulmonary arrest', Chest, vol. 98, no. 6, pp. 1388-1392.
Schein R, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990 Dec 1;98(6):1388-1392.
Schein, Roland ; Hazday, N. ; Pena, M. ; Ruben, B. H. ; Sprung, C. L. / Clinical antecedents to in-hospital cardiopulmonary arrest. In: Chest. 1990 ; Vol. 98, No. 6. pp. 1388-1392.
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