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Outcomes after cardiac arrest in an adult burn center
Jonathan C Wilton1, Mark O Hardin, John D Ritchie
1United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, United States.
Insights
Cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) in adult burn patients are rare but survivable. Survival is unlikely with CPR longer than 7 minutes, indicating potential futility in prolonged resuscitation efforts.
Area of Science:
- Critical Care Medicine
- Burn Surgery
- Emergency Medicine
Background:
- Adult burn patients represent a unique population for in-hospital cardiac arrest (CA).
- These patients are often younger and have the added burden of severe burn injuries.
Purpose of the Study:
- To determine the incidence of CA and cardiopulmonary resuscitation (CPR) in adult burn patients.
- To identify the causes and outcomes of CA and CPR in this specific patient group.
Main Methods:
- Retrospective review of adult burn patients experiencing in-hospital CA and CPR at the US Army Institute of Surgical Research Burn Intensive Care Unit (BICU) from 2000-2009.
- Data included civilian burn patients and casualties from Iraq and Afghanistan conflicts.
- Exclusion criteria: CPR outside BICU/OR, and patients with do-not-resuscitate orders.
Main Results:
- An incidence of 34 CA per 1000 admissions (0.34%) was observed.
- Survival to discharge was 25% (14 patients), with 75% (43 patients) mortality.
- Pulseless electrical activity was the most common initial rhythm (50.9%), and respiratory failure was the most common cause of CA (49.1%).
Conclusions:
- Cardiopulmonary resuscitation can be effective in select burn patients, potentially leading to good neurological outcomes.
- Prolonged CPR exceeding 7 minutes was not associated with survival, suggesting futility.
- Multiple cardiac arrests significantly decrease the likelihood of survival to discharge.
Objective:
Adult burn patients who experience in-hospital cardiac arrest (CA) and undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest (CA) and cardio-pulmonary resuscitation (CPR) within this population.
Methods:
We conducted a retrospective review at the US Army Institute of Surgical Research (ISR) burn intensive care unit (BICU). Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced in-hospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate (DNR) orders were excluded.
Results:
We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions (0.34%). Fourteen of these patients (25%) survived to discharge while 43 (75%) died. The most common initial cardiac rhythm was pulseless electrical activity (50.9%). The most common etiology of CA among burn patients was respiratory failure (49.1%). The most significant variable affecting survival to discharge was duration of CPR (P < 0.01) with no patient surviving more than 7 min of CPR.
Conclusions:
CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile. Further, those who experience multiple CA are unlikely to survive to discharge.
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