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Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit

Blair C Schwartz1, Dev Jayaraman, Paul J Warshawsky

  • 1Division of General Internal Medicine, McGill University, Montreal, Québec, Canada. b.schwartz@sympatico.ca

The Canadian Journal of Cardiology
|May 30, 2012
PubMed

Insights

In-hospital cardiac arrest (IHCA) on internal medicine units has a very low survival rate, especially for unwitnessed arrests. These outcomes highlight the need for careful consideration in code status discussions.

Area of Science:

  • Internal Medicine
  • Cardiology
  • Critical Care Medicine

Background:

  • Limited data exists on patient outcomes after in-hospital cardiac arrest (IHCA) in internal medicine clinical teaching units (CTUs).
  • Accurate outcome data is crucial for informed discussions between patients, surrogates, and physicians regarding patient management.

Purpose of the Study:

  • To investigate patient outcomes following in-hospital cardiac arrest (IHCA) on internal medicine clinical teaching units (CTUs).
  • To provide data that can enhance code status discussions and guide clinical management.

Main Methods:

  • A retrospective cohort study of "Code Blue" calls was conducted on two medical CTUs in a Canadian tertiary center.
  • Data from 83 eligible patients between January 2003 and June 2007 were analyzed, focusing on patient and arrest-specific factors.
  • The primary outcome measured was survival to hospital discharge.

Main Results:

  • The cohort included 83 patients (65.1% male, mean age 75 years), with infection being the most common reason for admission.
  • Over half of the patients had three or more comorbidities; 51.8% of IHCA events were witnessed.
  • Survival to hospital discharge was low (2.4%), with no survivors among patients experiencing unwitnessed arrests. Most arrests were pulseless electrical activity (PEA) or asystole.

Conclusions:

  • In-hospital cardiac arrest (IHCA) on internal medicine CTUs is associated with a high incidence of PEA/asystole and a very low survival rate to hospital discharge.
  • No patients with unwitnessed arrests survived to discharge, underscoring the critical nature of these events.
  • These findings necessitate further validation in larger studies and warrant careful consideration during code status discussions, particularly regarding unwitnessed arrests.
Abstract

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