Risk of cardiopulmonary arrest after acute respiratory compromise in hospitalized patients

Abstract

Background: Hospitalized patients with serious medical conditions such as shock, aspiration, pulmonary edema or stroke may develop acute respiratory compromise (ARC) requiring rescue treatment by medical emergency teams. We determined the characteristics and clinical course of hospitalized patients experiencing ARC as well as their risk of developing subsequent CPA.

Methods: We examined data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). We identified patients experiencing ARC, defined as medical crisis requiring emergency assisted ventilation and triggering hospital-wide or unit-based emergency response. We excluded those found initially in CPA. We identified the proportion of patients subsequently progressing to CPA, the elapsed time from ARC recognition to CPA, the clinical factors associated with developing CPA, and subsequent survival to hospital discharge.

Results: Of 4358 ARC events, CPA occurred in 726 (16.7%; 95% CI: 15.6, 17.8%). One-fourth occurred in general inpatient units. Median time from ARC recognition to CPA was 7 min (IQR: 3, 12 min); CPA occurred within 10 min in 65.3% of these cases. Factors associated with CPA included pulmonary embolism, hypotension or hypoperfusion, or failed invasive airway efforts. Survival to discharge was lower for CPA patients (14.3%) than non-CPA patients (58.4%) (OR 0.12; 95% CI: 0.10, 0.15).

Conclusions: Approximately one in six patients experiencing initial ARC deteriorates to CPA. Most CPA occur within 10 min of ARC recognition. Improved ARC recognition, hospital emergency team response and airway management may potentially enhance care and outcomes for these critically ill patients.