Journal
RESUSCITATION
Volume 98, Issue -, Pages 112-117Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2015.08.016
Keywords
Cardiopulmonary resuscitation; Heart arrest; Heart rate; Blood pressure; Respiration; Mortality
Categories
Funding
- NHLBI [1K02HL107447-01A1]
- American Heart Association [14GRNT200100002, 13CRP16930000, 15SDG22420010]
- NIGMS [1K23GM101463-01K1]
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K02HL107447] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES [K23GM101463] Funding Source: NIH RePORTER
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Background: Patients suffering in-hospital cardiac arrest often show signs of physiological deterioration before the event. The purpose of this study was to determine the prevalence of abnormal vital signs 1-4 h before cardiac arrest, and to evaluate the association between these vital sign abnormalities and in-hospital mortality. Methods: We included adults from the Get With the Guidelines (R) - Resuscitation registry with an in-hospital cardiac arrest. We used two a priori definitions for vital signs: abnormal (heart rate (HR) <= 60 or >= 100 min(-1), respiratory rate (RR) <= 10 or >20 min(-1) and systolic blood pressure (SBP) <= 90 mm Hg) and severely abnormal (HR <= 50 or >= 130 min(-1), RR <= 8 or >= 30 min(-1) and SBP <= 80 mm Hg). We evaluated the association between the number of abnormal vital signs and in-hospital mortality using a multivariable logistic regression model. Results: 7851 patients were included. Individual vital signs were associated with in-hospital mortality. The majority of patients (59.4%) had at least one abnormal vital sign 1-4 h before the arrest and 13.4% had at least one severely abnormal sign. We found a step-wise increase in mortality with increasing number of abnormal vital signs within the abnormal (odds ratio (OR) 1.53 (CI: 1.42-1.64) and severely abnormal groups (OR 1.62 (CI: 1.38-1.90)). This remained in multivariable analysis (abnormal: OR 1.38 (CI: 1.28-1.48), and severely abnormal: OR 1.40 (CI: 1.18-1.65)). Conclusion: Abnormal vital signs are prevalent 1-4 h before in-hospital cardiac arrest on hospital wards. In-hospital mortality increases with increasing number of pre-arrest abnormal vital signs as well as increased severity of vital sign derangements. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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