In-hospital Cardiac Arrest - Dynamics and State Transitions

• Survival to discharge [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  

• Short-term survival [ Time Frame: minutes-days ] [ Designated as safety issue: No ]
  

Procedure: Cardiopulmonary resuscitation (CPR)
CPR is performed according to international and national guidelines on all patients.
Other Name: CPR
Drug: Epinephrine
According to guidelines epinephrine 1 mg i.v. is administered every 3 minutes during cardiopulmonary resuscitation.
Other Name: Adrenaline
Drug: Atropine
According to CPR guidelines atropine 3 mg i.v. is administered if asystole og PEA with frequency < 60 beat/min.
Drug: Amiodarone
According to guidelines amiodarone 300 mg i.v. is administered if recurrent ventricular fibrillation/tachycardia (VF/VT) during CPR.
Other Name: Cordarone
Device: External defibrillator
According to CPR guidelines patients with shockable rhythms may receive DC shocks. The defibrillator also stores physiological information regarding cardiac rhythm, pulse-oximetry, and end-tidal CO2 from endotracheal tube.
Other Name: Defibrillator

In-hospital cardiac arrest carries a grave prognosis, with survival to discharge in the range of 15-20%. Key factors determining outcome include the presenting cardiac rhythm, aetiology, and early initiation of resuscitation. Some cardiac rhythms benefit from defibrillation (shockable rhythms). During resuscitation patients may switch between shockable and non-shockable rhythms, and may show signs of spontaneous circulation temporarily. Depending on rhythm and according to guidelines, patients receive DC shocks (defibrillator) and/or i.v. adrenaline, atropine and amiodarone, which may affect state-transitions. We wish to make statistical analysis (time-series analysis, Markov modelling) of these state-transitions and variations in hemodynamic variables during resuscitation, related to CPR interventions and the cause of arrest. The cause of arrest will be determined based on chart records, interview with staff and autopsy if appropriate. One hypothesis is that differences in the patterns of state-transitions may reflect underlying aetiology, which may guide in future decision-making during resuscitation.