Cardiac arrest in ICU: the Ultstein method results in general intensive care

Objective

Despite the high incidence of cardiac arrest (CA) in ICU, this situation is poorly notified and analyzed, not only in ICU but also in other clinics. Most registrations refer to out-of-hospital or emergency units CA and their causes, initial rhythm and prognosis are very distinct from CA in ICU. Ultstein method is a model of CA notification recommended by American Heart Association (AHA) and Brazilian Society of Cardiology. Our objective is to describe the first results of Ultstein method in our ICU.

Methods

Ultstein forms notifying CA between April 1999 and January 2000 were analyzed. Doctors or nurses involved in the resuscitation efforts filled out the forms.

Results

We registered 55 cases from 146 CA occurred in 539 ICU admissions. Mean APACHEII score was 23.93, with 45.75% of mortality risk. The most frequent causes were metabolic disturbances (29.2%), shock (25.5%), hypoxemia (23.5%), cardiac ischemia (10.9%), brain death in organ donors (7.2%), pulmonary embolism (1.8%) and unknown (21.8%). The recognized rhythms were asystole (47.3%), bradycardia followed by asystole (29.1%), pulseless electrical activity (18.2%) and ventricular fibrillation or pulseless ventricular tachycardia (5.4%). Despite good initial results, the follow-up evaluation demonstrated that only 10.9% of the patients were discharged from hospital. After 6 months, 50% were alive but none of them was alive after 1 year. The other patients (90.1%) died during the admission period. The main cause of these deaths was multiple organ dysfunction (57.1%), followed by brain death (28.6%, including the organ donors), cardiac ischemia (8.2%) and respiratory disease (6.1%).

Conclusion

Intrahospital CA notification is important to allow a comparison with those that occur outside the hospital. Moreover, it allows us to know how CA is managed and how we can optimize the patient assistance.