1. 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
.
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.