Correspondence Journal of the Intensive Care Society 2017, Vol. 18(2) 173 ! The Intensive Care Society 2016 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav DOI: 10.1177/1751143716674227 journals.sagepub.com/home/jics
Cardiac arrest in ICU James Cook1 and Matt Thomas2
The true incidence and outcome of cardiac arrest within the intensive care unit (ICU) is unknown. In a systematic review, Efendijev et al.1 noted the incidence of ICU cardiac arrest varied from 5.6 to 78.1 cardiac arrests per 1000 ICU admissions. They concluded ‘data on intensive care unit cardiac arrest is quite limited and. . . the quality of data overall seems to be moderate’ and recommended focused prospective multicentre studies. Southmead Hospital, Bristol has a 42-bed neurosciences, trauma and general ICU with 2000 admissions annually. Using Wardwatcher2 data since January 2015, we determined that the incidence of cardiac arrest requiring cardiopulmonary resuscitation (CPR) in our unit was 25 cardiac arrests per 1000 admissions. Overall, 56 patients received CPR on a total of 75 occasions. The range of episodes of CPR per patient during ICU admission was 1–5 with a median of 1 episode and 11 patients receiving CPR on more than one occasion. Reflecting closely the case mix of our ICU, 52% (29/56) were from surgical specialities, 46% (26/56) from medical specialities and 2% (1/56) were obstetric; 59% (33/56) were male and 41% (23/ 56) female. Compared to those who did not, patients who did receive CPR were older (63.08 17.51 and 58.45 18.19 years), a greater proportion were unplanned admissions (69.6% and 54.6%), more had CPR prior to admission (17.8% and 3.5%) and they had a higher mean Intensive Care National Audit and Research Centre (ICNARC) predicted mortality score (53.8 30.79 and 18.92 23.65). Those receiving CPR had a median length of ICU stay of 4.6 days (22.7 days in unit survivors) compared to median 3.1 days in those who did not. Importantly, 69.6% of patients who received CPR in the ICU died compared to 10.5% of those who did not. The standardised mortality ratios for comparison are 1.29 (0.92–1.72) and 0.55 (0.49– 0.62) for CPR and no CPR, respectively. These are clinically significant differences between the CPR and no CPR groups for key outcomes like length of stay and unit mortality. There did not appear to be significant differences between those who survived and those who died following CPR (data not shown), but caution is necessary given the small data set. ICNARC’s Case Mix Programme3 does not collect data on cardiac arrest in ICU. Nor is data on cardiac arrest in ICU collected for the National Cardiac
Arrest Audit (NCAA),4 also run by ICNARC, as a ‘2222’ call is not made. Data collected for the NCAA include day and time of arrest, presenting rhythm, duration of resuscitation attempt and reason resuscitation stopped. In addition to the data already collected by the Case Mix Programme, inclusion of these data would allow more detailed prospective multicentre analysis of cardiac arrest in ICU. We believe ICNARC should modify the Case Mix Program to include the NCAA dataset for cardiac arrest in ICU. Case mix adjusted incidence could be a key performance indicator for quality of care. More importantly, better data would allow strategies to predict and prevent cardiac arrest in the ICU, delivering better outcomes for patients. Acknowledgement This work was performed at Southmead Hospital, Bristol.
Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Efendijev I, Nurmi J, Castren M, et al. Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature. Resuscitation 2014; 85: 472–479. 2. Wardwatcher, www.sicsag.scot.nhs.uk/data/wardWatcher. html (accessed 18 August 2016). 3. Intensive Care National Audit and Research Centre Case Mix Programme, www.icnarc.org/Our-Audit/ Audits/Cmp/About (accessed 18 August 2016). 4. National Cardiac Arrest Audit, https://ncaa.icnarc.org/ Home (accessed 18 August 2016).
1 Department of Anaesthetics, Glangwili General Hospital, Carmarthen, UK 2 Southmead Hospital, Bristol, UK
Corresponding author: James Cook, Department of Anaesthetics, Glangwili General Hospital, Dolgwilli Road, Carmarthen SA31 2AF, UK. Email: [email protected]