Outcomes following admission to ICU post cardiac arrest

Introduction

ICU admission post cardiac arrest accounts for 6% of admissions to the ICU [1]. ICU survival post cardiac arrest ranges from 25% to 35% [2]. We reviewed the records of both out-of-hospital and inhospital cardiac arrest admissions to our ICU to audit their outcomes, the primary outcome variable being survival to ICU and hospital discharge. Secondary objectives were to determine the length of stay in the ICU and hospital of both survivors and nonsurvivors.

Methods

We performed a retrospective review of all admissions to our ICU post cardiac arrest between January 2003 and December 2006. Our data were sourced from the ICU access database, ICU discharge summary and individual chart review. We recorded demographics and data regarding each arrest.

Results

One hundred and forty-seven patients were admitted to our ICU during the 4-year period. The mean age was 59 years, ranging from 16 to 88 years. Out-of-hospital cardiac arrest accounted for 51% (n = 75) of cases, inhospital cardiac arrest for 49% (n = 72). Asystole was the first identifiable rhythm in 39%, of which 21% survived to hospital discharge, 42% of whom had a poor neurological outcome. Ventricular fibrillation/ventricular tachycardia accounted for 32% of cases, of which 39% survived, all of whom had a good neurological outcome. Pulseless electrical activity accounted for 29% of cases, of which 25% survived to hospital discharge, 10% of whom had a poor neurological outcome. Overall survival was 27%, of which 15% had a poor neurological outcome. The mean ICU length of stay was 9.2 days for survivors and 6.8 days for nonsurvivors.

Conclusion

The high prevalence of asystole in both groups is not in keeping with previous audit series [3] in which ventricular fibrillation/ventricular tachycardia is the predominant arrest rhythm and may reflect a delayed response time. Our survival figures are comparable with international data [3], which are limited. The higher male to female ratio is consistent with previous audit series [4], possibly reflecting the higher incidence of ischaemic heart disease in males.