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Observational Study
. 2016 Oct-Dec;28(4):427-435.
doi: 10.5935/0103-507X.20160076.

Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

[Article in Portuguese, English]
Rose Mary Ferreira Lisboa da Silva  1 , Bruna Adriene Gomes de Lima E Silva  1 , Fábio Junior Modesto E Silva  1 , Carlos Faria Santos Amaral  1
Affiliations
Observational Study

Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

[Article in Portuguese, English]
Rose Mary Ferreira Lisboa da Silva et al. Rev Bras Ter Intensiva. 2016 Oct-Dec.

Abstract
in English, Portuguese

Objective:: The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style.

Methods:: This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year.

Results:: The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively.

Conclusions:: The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

Objetivo: Analisar o perfil clínico de pacientes com parada cardiorrespiratória intra-hospitalar, seu atendimento e evolução, com registro baseado no estilo Utstein.

Métodos: Estudo observacional, prospectivo e longitudinal em ambiente de terapia intensiva de pacientes com parada cardiorrespiratória incluídos durante 1 ano.

Resultados: Foram 89 pacientes, com média de idade de 59,0 anos, 51,6% homens, submetidos às manobras de ressuscitação cardiopulmonar. Os episódios ocorreram no período diurno em 64,6% dos casos. A assistolia/bradiarritmia foi o ritmo inicial mais frequente (42,7%). A maior parte dos que apresentaram retorno à circulação espontânea evoluiu com parada cardiorrespiratória recorrente, principalmente nas primeiras 24 horas (61,4%). As médias dos tempos foram de 10,3 dias entre a internação e ocorrência de parada cardiorrespiratória; 0,68 minutos entre a parada cardiorrespiratória e ressuscitação cardiopulmonar; 7,1 minutos entre a parada cardiorrespiratória e a desfibrilação; 16,3 minutos de duração da ressuscitação cardiopulmonar. Houve associação entre sexo e duração da ressuscitação cardiopulmonar (19,2 minutos nas mulheres versus 13,5 minutos nos homens; p = 0,02), duração da ressuscitação cardiopulmonar e retorno à circulação espontânea (10,8 minutos versus 30,7 minutos; p < 0,001), entre cardiopatia e a idade (60,6 anos versus 53,6; p < 0,001). A sobrevida imediata após a parada cardiorrespiratória foi de 71% e, até a alta hospitalar e no sexto mês após a alta, de 9% e de 6%, respectivamente.

Conclusão: O principal ritmo inicial detectado foi a assistolia/bradiarritmia com curto intervalo entre a parada cardiorrespiratória e a reanimação, porém com desfibrilação tardia. Mulheres apresentaram maior tempo de reanimação. Houve baixa taxa de sobrevida hospitalar.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Devices used prior to cardiac arrest. ICD - implantable cardioverter-defibrillator.
Figure 2
Figure 2
Causes of the 96 episodes of cardiac arrest, with the number of patients and their percentage. Others - hypoxia, orotracheal tube obstruction, pneumothorax and cardiogenic shock.
See this image and copyright information in PMC

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