Resumen
Este estudio investigó la epidemiología y predictibilidad de los paros cardíacos intra-hospitalarios (IHCAs) en hospitales australianos con equipos médicos de emergencia (METs) establecidos.
Se categorizaron los IHCAs en tres grupos basados en factores como la edad y el estado de salud del paciente, así como en los signos vitales documentados previos al paro.
Se encontró que solo un tercio de los IHCAs fueron repentinos e inesperados, lo que sugiere que mejorar la atención al final de la vida en pacientes ancianos y mejorar la respuesta a los signos objetivos de deterioro podrían reducir aún más la incidencia de IHCAs en el contexto australiano.
Prevención y tratamiento de complicaciones tras paro cardiaco en fisioterapia
Los fisioterapeutas desempeñan un rol crucial en la prevención de IHCAs mediante la detección temprana y la aplicación de cuidados paliativos. En el ámbito de las clínicas de fisioterapia, estos profesionales pueden contribuir significativamente en la prevención y tratamiento de complicaciones posteriores a un paro cardiaco, mejorando así la calidad de vida de los pacientes.
Abstract original
Antecedents to and outcomes for in-hospital cardiac arrests in Australian hospitals with mature medical emergency teams: A multicentre prospective observational study
Background: The epidemiology and predictability of in-hospital cardiac arrests (IHCAs) in hospitals with established medical emergency teams (METs) is underinvestigated.
Objectives: We categorised IHCAs into three categories: "possible suboptimal end-of-life planning" (possible SELP), "potentially predictable", or "sudden and unexpected" using age, Charlson Comorbidity Index, place of residence, functional independence, along with documented vital signs, K+ and HCO3 in the period prior to the IHCA. We also described the differences in characteristics and outcomes amongst these three categories of IHCAs.
Methods: This was a prospective observational study (1st July 2017 to 9th August 2018) of adult (18 years) IHCA patients in wards of seven Australian hospitals with well-established METs.
Results: Amongst 152 IHCA patients, 145 had complete data. The number (%) classified as possible SELP, potentially predictable, and sudden and unexpected IHCA was 50 (34.5%), 52 (35.8%), and 43 (29.7%), respectively. Amongst the 52 potentially predictable patients, six (11.5%) had missing vital signs in the preceding 6 hr, 18 (34.6%) breached MET criteria in the prior 24 hr but received no MET call, and 6 (11.5%) had a MET call but remained on the ward. Abnormal K+ and HCO3 was present in 15 of 51 (29.5%) and 13 of 51 (25.5%) of such patients, respectively. The 43 sudden and unexpected IHCA patients were mostly (97.6%) functionally independent and had the lowest median Charlson Comorbidity Index. In-hospital mortality for IHCAs classified as possible SELP, potentially predictable, and sudden and unexpected was 76.0%, 61.5%, and 44.2%, respectively (p = 0.007). Only four of 12 (33.3%) possible SELP survivors had a good functional outcome.
Conclusions: In seven Australian hospitals with mature METs, only one-third of IHCAs were sudden and unexpected. Improving end-of-life care in elderly comorbid patients and enhancing the response to objective signs of deterioration may further reduce IHCAs in the Australian context.
| Autores | ANZ-CODE Investigators |
| revista | Aust Crit Care |
| DOI | 10.1016/j.aucc.2023.01.011 |