Adult cardiac arrest in the emergency department - A Swedish cohort study

Abstract

Background: Cardiac arrests occurring in emergency departments (ED) represent 10-20% of all in-hospital cardiac arrests (IHCA). Yet few studies have examined the characteristics and outcomes of IHCA occurring in the ED. The aim was to describe this population in a nationwide registry covering all EDs in Sweden.

Methods: Patients ≥18 years with an IHCA in the ED reported to the Swedish Registry for Cardio-Pulmonary Resuscitation (SRCR) during 2007-2018 were included. Descriptive statistics were calculated.

Results: We identified 2,604 (10 % of all IHCA in SRCR) ED arrests; 902 (35%) survived to hospital discharge and 672 (75%) had good neurological outcomes (Cerebral Performance Category 1-2). The national incidence rate 2016-2018 was 1.6 (range 1.60-1.70) cardiac arrests per 10,000 ED visits. Over 90% were witnessed and 26% had a shockable first rhythm. Three presumed aetiologies together explained half of the cases; myocardial ischaemia (30%, n = 789), primary arrhythmia (12%, n = 327) and respiratory insufficiency (10%, n = 265). At a subset of ED arrest at Karolinska University Hospital, half of the cardiac arrests occurred within one hour from arrival to the ED.

Conclusion: About 10% of all IHCA occurs in ED, however, from an ED perspective it is a rare event. Cardiac arrests in the ED generally occur within an hour from arrival to the ED. One in three survive to discharge from hospital and the majority of survivors have a good neurological outcome.

Keywords: Emergency medicine; Incidence; Triage.