Cardiac Arrest in Emergency Department

Lee, Sung Woo; Hong, Yun Sik

Abstract

BACKGROUND: Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. But we do not know the true effectiveness of resuscitation. Studies originated from different settings and have different patient population. These differences prevent valid interhospital and international comparisons. There are no guidelines for reviewing, reporting, conducting research on resuscitation in Korea. To develop these guidelines, we research on resuscitation in emergency department.
METHODS
Seventy eight patients were retrospectively reviewed, who confirmed cardiac arrest in Emergency Department of Korea University Hospital from May, 1997 to February, 1999. Of 78 patients, 8 were excluded due to declare "DNR(do not resuscitation)". Parameters analyzed were age, sex, place arrested, collapse to start of CPR, collapse to first dose epinephrine, collapse to first defibrillation shock, collapse to advanced airway, collapse to stop of CPR interval, cause of arrest, arrest witnessed, initial rhythm, ROSC(return of spontaneous circulation), and discharged alive. We used reporting form based on "Utstein Style ". RESULT: Of 78 patients, the mean age was 58 years old. Thirty four patients were arrested out of hospital. The mean age was 48.74 +/-21.3 years old, mean CPR time 33.00 +/-17.8min. Percent successfully resuscitated was 41.2%(14/34), percent survival from the arrest to at least 24hours 8.8%(3/34), percent survival from arrest to discharge 2.9%. Number of cardiac etiology was 12(35.2%), witnessed arrest 28(82.3%), ventricular fibrillation or tachycardia 1(2.9%) and its percent successfully resuscitated 25%, 42.8%, 0%, respectively. Forty four patients were arrested in emergency department, 8 were excluded due to declare "DNR(do not resuscitation )". The mean age was 61.72 +/-12.9 years. Percent successfully resuscitated was 58.3%(21/36), percent survival from the arrest to at least 24hours 27.8%(10/36), percent survival from arrest to discharge 25.0%(9/36). The mean CPR time in patients of ROSC was 19.81 +/-22.3 minute, and shorter than non-ROSC( p>0.05). Patients discharged alive had shorter interval of each event(collapse to start of CPR, 1.78 +/- 1.5min, to first defibrillation, 2.29 +/-1.3min, to first dose epinephrine 2.67 +/-3.8, to stop of CPR, 11.56 +/- 17.6min) than patients died in hospital(p<0.05). Number of cardiac etiology was 18(50.0%), monitored arrest 30(83.3%), ventricular fibrillation or tachycardia 12(33.9%) and its percent successfully resuscitated 61.1%, 53.3%, 83.3%, and its percent survival from arrest to discharge 33.3%, 23.3%, 58.3% respectively.
CONCLUSION
Initial rhythm of patients discharged alive was mainly ventricular defibrillation and tachycardia(89%). Early patient access and defibrillation are essential to resuscitation. Develope EMS is needed to improve outcome of resuscitation and standard guideline for resuscitation is needed for medical control.