Characteristics, management process, and outcome of patients suffering in-hospital cardiopulmonary arrests in a teaching hospital in Hong Kong

HY Yap, Thomas ST Li, KS Tan, YS Cheung, PT Chui, Philip KN Lam, Desmond WL Lam, YF Tong, MC Chu, PN Leung, Gavin M Joynt
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong

OBJECTIVES. To examine the demographics, process indicators of adult in-hospital cardiopulmonary arrest resuscitation, and outcomes in a teaching hospital in Hong Kong.

DESIGN. Retrospective study.

SETTING. A university-affiliated tertiary referral hospital with 997 acute adult beds in Hong Kong.

PATIENTS. Those who suffered a cardiopulmonary resuscitation event, as documented in retrieved records of all in-patients during the inclusive period January 2002 to December 2005.

RESULTS. There were 531 resuscitation events; the mean (standard deviation) age of the corresponding patients was 70.7 (15.4) years. Most (83%) occurred in non-monitored areas and most (97%) were cardiopulmonary arrests. The predominant initial rhythm was asystole (52%); only 8% of patients had ventricular tachycardia/fibrillation. All the resuscitations were initiated by on-site first responders. The median times from collapse to arrival of the resuscitation team, to defibrillation, to administration of adrenaline, and to intubation were: 5 (interquartile range, 2-6) minutes, 5 (1-7) minutes, 5 (3-10) minutes, and 9 (5-13) minutes, respectively. The overall hospital survival (discharge) rate was 5%. The survival rate was higher among patients in monitored areas (9 vs 4%, P=0.046), among patients with isolated respiratory arrests (61 vs 3%, P<0.001), primary ventricular tachycardia/fibrillation arrests (13 vs 4%, P<0.001), shorter interval times from collapse to medication (1.5 vs 5 min, P=0.013), and longer interval times to intubation (12 vs 8 min, P=0.013).

CONCLUSION. Hospital survival after in-hospital cardiopulmonary arrests was poor. Possible strategies to improve survival include shorten time interval to defibrillation, and provision of more monitored beds.

Hong Kong Med J 2007;13:258-65

Key words: Cardiopulmonary resuscitation; Emergency Service, hospital; Heart arrest; Survival rate; Treatment outcome