IN-HOSPITAL CARDIOPULMONARY ARREST

Highlights

• The article presents a retrospective analysis of 281 cases of sudden cardiac arrest that occurred outside intensive care units in the Krasnoyarsk Regional Clinical Hospital for 2022-2024. The main epidemiological characteristics of patients, profiles of departments with the largest number of episodes of sudden cardiac arrest, features of temporary distribution and outcomes of resuscitation measures have been established.

Background. Sudden cardiac arrest (SCA) currently remains one of the most serious problems of the healthcare system. Cardiac arrest in the hospital is a potentially preventable condition. In some patients, cardiac arrest develops outside the intensive care unit: in the specialized department, in the hall, corridor, dialysis room, etc. This category of patients deserves special attention.

Aim: to study the characteristics, frequency and outcomes of SCA in patients undergoing inpatient treatment outside the intensive care units, in a multidisciplinary hospital and to evaluate the effectiveness of resuscitation measures for the development of measures to improve medical care for SCA.

Methods. An analysis was conducted of 281 cases of sudden circulatory arrest outside the intensive care unit that occurred in 2022–2024 in the Krasnoyarsk Regional Clinical Hospital

Results. In 2022, 2023 and 2024, 412 cases of cardiac arrest that occurred outside the intensive care units were recorded in the Regional Clinical Hospital. This work includes an analysis of 281 cases of cardiac arrest that occurred in specialized departments (264; 16.75%), in the hemodialysis room (8; 1.94%), in the multispiral computed tomography room (4; 0.97%) and in the hospital corridor or lobby (5; 1.21%). Cases of sudden cardiac arrest associated with a critical condition upon admission (the first hours of hospitalization) and cardiac arrest during surgical interventions were excluded. A significant proportion of patients were over 66 years of age (this group accounted for 68.68% – 193 patients), (χ² = 78.47, ρ < 0.001). There were no statistically significant differences between the number of women (151; 53.74%) and men (130; 46.26%) among patients (χ² = 3.139 ρ = 0.077). Most patients – 257 (91.46%) were admitted for emergency indications. Most often, sudden cardiac arrests occurred in the pulmonology (70; 24.91%), cardiology (42; 14.95%), neurology (40; 14.23%) and nephrology (38; 13.52%) departments. Among the reasons for hospitalization of patients, the most common were cardiovascular diseases (94; 33.45%), new coronavirus infection (43; 15.30%) and chronic renal failure (35; 12.46%). Sudden cardiac arrests occurred during the daytime in 152 cases (54.1%), at night – in 129 cases (45.9%), (χ² = 3.765 ρ = 0.053). It was possible to restore spontaneous cardiac rhythm in 88 patients (31.32%). Ten of them (3.56%) were discharged from the hospital. In the remaining cases – 193 patients (68.68%) biological death was stated as a result of ineffective resuscitation measures. Cardiovascular diseases as the initial cause of death were registered in 102 patients (37.64%), as the immediate cause of death in 105 (38.74%). In one patient (0.37%) sudden cardiac death was established as the immediate cause of death (I46.1 according to ICD 10).

Conclusion. It was established that sudden cardiac arrest outside the intensive care units in the Krasnoyarsk Regional Clinical Hospital amounted to 2.99 cases per 1000 hospitalizations, with such cases most often recorded in the pulmonology, cardiology and neurology departments. The average age of patients was 66.4 years, without significant gender differences. The main heart rhythm recorded on the ECG was asystole – 257 cases (91.46%). Restoration of cardiac activity was achieved in 88 cases (31.32%), 10 patients (3.56%) were discharged from the hospital. In 78 patients (27.76%), death occurred as a result of repeated cardiac arrest.

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