There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
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.