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Survival to discharge from in-hospital cardiac arrests (CA) remains poor. There is interest in prediction tools for earlier detection and intervention. Bradycardic arrests, spanning a spectrum of poorly perfusing rhythms from bradycardia to asystole, are a potential area of improvement given theoretically effective early treatments. In this study, we attempt to characterize mechanisms of bradycardic arrests to identify potential predictors of impending CA.
We evaluated CA cases at UCLA Medical Center between April 2010 and July 2012, included all adult CA cases with at least 3 hours of continuous telemetry data available immediately prior to CA. For CA characterized by Sinus arrest (SA), Sinus bradycardia (SB), or complete heart block (CHB), we examined up to 24 hours of telemetry data prior to CA for EKG changes.
15/75 (20%) of CA were bradycardic. Of these 9 (60%) were SA, 1 (7%) SB, 5 (33%) CHB. Resuscitation efforts resulted in return of spontaneous circulation in all patients without multiorgan failure by chronotropic agent administration, external pacing, and/or intubation but only 2 (13%) ultimately survived to discharge.
|Mechanism||Sinus Arrest||Sinus Bradycardia||Complete Heart Block|
|Total # of Cases||9/15 (60%)||1/15 (7%)||5/15 (33%)|
|# Cases by cause|
|Multiorgan Failure||4/9 (44%)||1/1 (100%)||2/5 (40%)|
|Respiratory Failure||3/9 (33%)||0/1 (0%)||2/5 (40%)|
|Other||2/9 (22%) – Cardiac failure, Drug-induced||0/1 (0%)||1/5 (20%) – Vagal induced|
|Return of Spontaneous Circulation||5/9 (56%)||1/1 (100%)||4/5 (80%)|
|Survival to Discharge||2/9 (22%) – 1 case due to Respiratory Failure, 1 drug-induced||0/1 (0%)||0/5 (0%)|
|Common Progression in EKG changes||Intermittent High degree AV block or Mobitz II block prior to CHB (5/5 cases) Progressive bundle branch block preceding high degree AV block and CHB (2/5 cases)|
|Time Prior to Arrest for first EKG Changes|
|≤ 10 minutes||6/9 (67%)||1/1 (100%)||2/5 (20%)|
|10 min – 1 hour||1/9 (11%)||0/1 (0%)||0/5 (0%)|
|≥ 1 hour||2/9 (22%)||0/1 (0%)||3/5 (60%)|
There is a bimodal distribution in time prior to CA of first EKG change in bradycardic arrests, with SA cases often having rapid onset of CA following EKG changes (≤ 10 minutes), and CHB cases having a slower onset (≥ 1 hour). Automated detection of common EKG changes preceding CA may alert clinicians to intervene earlier and more effectively.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Sudden Cardiac Death – Mechanisms and Treatment Strategies
Abstract Category: 6. Arrhythmias: Other
Presentation Number: 1192-58
- 2013 American College of Cardiology Foundation