Characteristics, etiologies and outcomes of cardiac arrest in the emergency department

Background: Emergency department cardiac arrests (EDCA) account for approxi-mately 10% of all in-hospital cardiac arrest (CA) events. However, data regarding EDCA remain scarce. Since EDCA has unique characteristics, etiologies, and outcomes, it should be considered distinct from out-of-hospital and in-hospital cardiac arrest. Methods: This study included adult patients who received cardiopulmonary resuscitation in our emergency department for EDCA between 01 January 2019, and 30 June 2023. Patients with a do-not-resuscitate order and those with trauma were excluded. On the basis of the assessment performed by emergency physicians, we divided the patients into unexpected and expected EDCA groups. Results: This study included 266 patients, of whom 93 had experienced an unexpected EDCA. Shockable initial rhythm was observed in 21.05% of the overall cohort. The incidence of initial shockable rhythms and the prevalence of end-stage renal disease were higher in the unexpected EDCA group (40.86% and 22.58%, respectively). The predominant etiologies of EDCA in the expected and unexpected EDCA groups were sepsis (24.86%) and shockable fatal dysrhythmia (40.86%), respectively. The overall probabilities of survival to hospitalization, survival to hospital discharge, and favorable neurological outcomes were 49.62%, 27.44%, and 12.41%, respectively. A trend toward better neurological outcomes was observed in the unexpected EDCA group. Conclusions: Expected and unexpected EDCA events differ in terms of characteristics, etiologies, and outcomes. To enhance care quality and prognosis, these differences should be considered when treatment is being planned for patients with EDCA.

Cardiac arrest; Emergency department cardiac arrest; Unexpected; Neurological outcome; Resuscitation

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