In-hospital cardiac arrest (IHCA) occurs when a patient’s heart suddenly stops beating effectively while admitted to a healthcare facility. This stops blood circulation throughout the body. IHCA is a medical emergency requiring immediate, coordinated intervention to restore heart activity and prevent harm.
Causes and Contributing Factors
Hospitalized patients often have underlying medical conditions that increase their susceptibility to cardiac arrest. Heart-related issues, such as severe heart disease, arrhythmias, or acute coronary syndrome, are common causes, accounting for approximately 50% to 60% of IHCA cases. Respiratory insufficiency, where the lungs cannot adequately supply oxygen, is another frequent cause, contributing 15% to 40% of incidents.
Other factors can also trigger IHCA. These include severe infections like sepsis, acute kidney injury, significant blood loss, or electrolyte imbalances such as potassium and magnesium, which can disrupt normal heart function. Complications from medical procedures or medication side effects may also precipitate an arrest.
The “Code Blue” Response
When a patient experiences IHCA, a hospital-wide alert known as a “Code Blue” is activated. This alert mobilizes a specialized team of healthcare professionals (physicians, nurses, and other trained staff) to the patient’s bedside. The swift response aims to restore spontaneous circulation and breathing.
Initial steps involve confirming absence of pulse or breathing and initiating high-quality cardiopulmonary resuscitation (CPR). Chest compressions are performed at 100-120 per minute, with a depth of 2-2.4 inches, allowing full chest recoil. Airway management is also a focus, with manual ventilation and preparations for advanced airway interventions like intubation.
A defibrillator is applied to assess the patient’s heart rhythm. If a “shockable” rhythm (e.g., ventricular fibrillation or pulseless ventricular tachycardia) is identified, defibrillation is administered to reset the heart’s electrical activity. Emergency medications, including epinephrine, are given per Advanced Cardiac Life Support (ACLS) guidelines to support heart function and blood pressure. The team continuously monitors vital signs, striving for the return of spontaneous circulation (ROSC).
Survival and Long-Term Outlook
The survival rate for in-hospital cardiac arrest varies, with approximately 26% of patients surviving to hospital discharge in the United States as of 2017. This outcome is influenced by factors like the patient’s underlying health, the arrest’s specific cause, and the speed of interventions like CPR and defibrillation. For instance, patients with an initial shockable rhythm tend to have better outcomes.
Recovery following IHCA extends beyond immediate survival and includes potential neurological outcomes. While some patients achieve good neurological recovery, post-cardiac arrest brain injury is a common concern due to oxygen deprivation. Post-resuscitation care, often involving transfer to an intensive care unit (ICU) for monitoring and stabilization, is important for optimizing recovery and addressing the arrest’s underlying cause.
Hospital Measures to Enhance Safety
Hospitals employ various strategies to prevent in-hospital cardiac arrest and improve outcomes when it occurs. Continuous patient monitoring, especially for critically ill individuals, allows early detection of physiological changes. Many facilities utilize early warning systems, such as the Modified Early Warning Score (MEWS), which assign a score based on vital signs (e.g., heart rate, respiratory rate, blood pressure). An elevated score can trigger an alert, prompting rapid assessment.
Rapid response teams (RRTs) are another proactive measure, consisting of specialized medical professionals who can intervene at the first signs of patient deterioration, potentially preventing cardiac arrest. These teams respond to early warning system triggers, providing timely assessment and treatment. Hospitals also regularly conduct staff training in resuscitation protocols and high-quality CPR to ensure providers are prepared to respond effectively during a Code Blue.