Outcomes After Cardiac Arrest in an Adult Burn Center
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Objective Adult burn patients who experience in-hospital cardiac arrest CA and undergo cardiopulmonary resuscitation CPR represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest CA and cardio-pulmonary resuscitation CPR within this population. Methods We conducted a retrospective review at the US Army Institute of Surgical Research ISR burn intensive care unit BICU. Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced inhospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate DNR orders were excluded. Results We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions 0.34. Fourteen of these patients 25 survived to discharge while 43 75 died. The most common initial cardiac rhythm was pulseless electrical activity 50.9. The most common etiology of CA among burn patients was respiratory failure 49.1. The most significant variable affecting survival to discharge was duration of CPR P 0.01 with no patient surviving more than 7 min of CPR. Conclusions CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile.
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