Survival from cardiopulmonary arrest after regular working hours in a tertiary-care hospital: retrospective study
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KeywordsCardiopulmonary Arrest Event Survival Good Clinical Outcome Retrospective Chart Review Hospital Staffing
Detection and treatment of cardiopulmonary arrest and their antecedents may be less effective at night and weekend than weekdays because of hospital staffing and response factors . Early detection and resuscitation of cardiopulmonary arrest are crucial for better clinical outcome. We conducted our study to evaluate event survival of in-hospital cardiopulmonary arrest after regular working hours in nonmonitored areas of a tertiary-care center.
A retrospective chart review of all adult patients who developed in-hospital cardiopulmonary arrest between January 2010 and December 2011. Working hours are defined as 07:00 to 17:00 Saturday to Wednesday. Event survival is defined as return of spontaneous circulation (ROSC) for more than 20 minutes. Adult patients 18 years and above who suffered from in-hospital cardiopulmonary arrest were included. Patients were excluded if they had cardiopulmonary arrest in the emergency department, had implantable cardiovascular device, arrested in monitored areas or had pre-existing DNR orders. Data analysis was accomplished using SAS, version 9.3 (SAS institute, Inc., Cary, NC, USA).
A total of 430 cardiopulmonary arrest events occurred in hospital between January 2010 and December 2011. A total of 326 patients were excluded because 252 occurred in the ICU, 70 in the coronary care unit and four in the stork unit. In total, 104 patients were enrolled; 50.9% where female and 49.1% male. Median age was 61 years. A total 41.3% of the arrests were due to respiratory arrest and 58.7% due to cardiac arrest. Out of 104 patients who developed cardiopulmonary arrest, 47 (45.19%) occurred during regular working hours, and 57 (54.81%) occurred after regular working hours (P = 0.0081). The event survival was 87.23% during regular working hours compared with 47.37% for the patients who developed cardiopulmonary arrest after regular working hours (P < 0.0001). In total, 53.19% of those who developed cardiopulmonary arrest during regular working hours were discharged alive from the ICU compared with 26.32% of those who developed cardiopulmonary arrest after regular working hours.
Event survival and survival to discharge were significantly higher in patients who developed cardiopulmonary arrest during regular working hours.
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