Abstract

Background: Hospitalised patients requiring cardiopulmonary resuscitation (CPR) have better outcomes in intensive care units (ICUs) than wards. Survival could potentially be improved for patients at high risk for CPR if they can be identified while in the emergency department (ED) and admitted to an ICU setting. It is currently unknown whether patients requiring CPR who are admitted to the ward show a similar pattern of physiological deterioration to those admitted to the ICU, and thus whether future research should consider these two patients groups as distinct. It is hypothesised that, since both groups of patients decompensate to the point of requiring acute resuscitation shortly after hospital admission, they should also share similar premonitory signs of deterioration in their basic physiological parameters.

Methods: A retrospective chart review was performed of adult patients at an urban ED requiring CPR within 72 h of admission from March 2002 to March 2005. Data were compared between subjects admitted to ICU and non-ICU beds.

Results: 45 patients (58% women) of mean age 59 years met the inclusion criteria; 40% required CPR in a non-ICU ward. There were no differences in demographic characteristics, ED chief complaint or admission diagnosis between the two groups. Blood pressure was significantly higher in the non-ICU subjects at ED arrival (129/75 vs 100/50), time of admission (122/74 vs 103/58) and before CPR (117/70 vs 92/50) (p⩽0.054). Non-ICU subjects had higher pulse and respiratory rates at the last measurement before CPR (pulse 109 vs 88, p = 0.004; respiratory rate 26 vs 17, p = 0.002).

Conclusion: This study indicates that patients who experience CPR after admission to non-ICU wards may have a different pattern of physiological deterioration from patients admitted to an ICU. Further studies to derive decision criteria in admitting patients at risk for inpatient CPR should treat these patient populations as separate.