Dr. Srihari Cattamanchi, 10-72, Gandhi Road Extn, Chittoor – 517001. Andhra Pradesh. India. Mobile: +91-9994616329. Email: c.srihari@gmail.com

Code Blue – A prospective evaluation of effectiveness of CPR of inhospital cardiac arrests in a tertiary care university hospital, S.India 

Dr. SRIHARI CATTAMANCHI*, Dr. Nishanth Hiremath, Dr. Srinivas Reddy Banala, Dr. Trichur V. Ramakrishnan

Sri Ramachandra Medical College & Research Institute, Porur, Chennai – 600116. T.N. India.

Objectives

Background

Results

Conclusions

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Methods

• To determine demographic data and survival for in - hospital cardiac arrests.

• To examine effects of age, sex, and initial cardiac rhythm on circadian variability in sudden cardiac death.

• In-hospital sudden cardiac death demonstrated circadian variation, and this variability was observed regardless of the patient's age, sex, or initial cardiac arrest rhythm. The outcome of resuscitation did not show circadian variability. These results suggest a common pathophysiologic mechanism leading to sudden cardiac death.

• One hundred ninety patients underwent cardiac resuscitation, with 69 (36.3%) surviving for 1 hour, 25 (5.1%) survived to discharge.

• The 190 patients had the following data: mean age 60.37 years (range 19 – 89 years of age); male 53.0%; witnessed arrest 25.6%; duty doctor cardiopulmonary resuscitation 32.1%; initial rhythm ventricular fibrillation/ventricular tachycardia 86.9%.

• Overall, neurologically intact survival was 1.4% (99% confidence interval [CI] 0.8% to 2.4%)

• Three patients were lost to follow-up. • A circadian variation in the occurrence of

sudden cardiac death was demonstrated, with a low occurrence rate between midnight and 6 AM and a 2.5 fold increase between the rate at 6 AM and noon.

• A peak was noted between 6 Am and 9 AM accounting for 33% of all cardiac Arrests with 27 deaths (14%) between 9:00 to 9:59 AM.

• The same circadian pattern was noted among both men and women, among both patients aged 18 to 70 and those older than 70 years, and among patients with various initial cardiac arrest rhythms.

• However, the outcome of resuscitation in these patients did not demonstrate circadian variation.

• Design: A prospective observational study of adult patients.

• Setting: Sri Ramachandra Medical College & Research Institute, Chennai, S.India.

• Duration: 1st January to 31st December 2009.

• Inclusion: Patients admitted with non-traumatic cause, undergoing cardiac arrest and attempted resuscitation were included in study.

• Data Collected: Entry criteria, time intervals, nodal events and arrest factors related to resuscitation outcome were recorded.

• Single target endpoint was neurologically intact survival at hospital discharge.

• Instrument: Preformatted Questionnaire.• Statistical Analysis: done using SPSS ver. 17.

The American Heart Association has highlighted the chain of survival to guide the priority of interventions for basic life support, including early arrival of professional rescuers, early CPR, and early defibrillation.Professional rescuers in hospitals are now provided with an expanded resource of therapeutic options, both devices and drugs. Nevertheless, these again have not objectively improved overall survival rates. The expectations of lay public are otherwise. Electronic media and especially current emergency room television dramas on comprehensively monitored simulated victims persuade the onlooker that CPR is almost inevitably life restoring and therefore there is expectation of successful outcomes. To the contrary, in-hospital cardiac arrest (IHCA) at end stage of disease and especially in nonmonitored patients in conventional medical/surgical wards has a low probability of survival.