Chew Keng, Sheng
(2010)
13th International Conference on Emergency Medicine Singapore 9-12 Jun 2010.
Other.
Pusat Pengajian Sains Perubatan.
(Submitted)
Abstract
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.
Methods : A prospective observational study of adult patients in
S.lndia from January to December 2009. Patients admitted with
non-traumatic cause, undergoing cardiac arrest and attempted
resuscitation were Included in study. 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.
Results : 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 bata:
mean age 63.9 years; male 78.0%; 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 tow occurrence rate between midnight
and 6 AM and a 2.4-fold increase between the rate at 6 AM and
the rate at noon. 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 (ventricular tachycardia or fibrillation,
asystole, and electromechanical dissociation). However,
the outcome of resuscitation in these patients (le, the rate of
successful resuscitation and the rate of survivaQ did not
demonstrate circadian variation.
Discussion : 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.
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