The results of the study will be presented at the American Thoracic Society's 2011 International Conference in Denver.
"We found a compelling signal that some patients with pneumonia may develop cardiac arrest outside of the ICU, without apparent shock or respiratory failure," said lead investigator Gordon Carr, MD, pulmonary and critical Care fellow, at the University of Chicago Medical Center. "If this is true, then we need to improve how we assess risk in pneumonia."
Dr. Carr and colleagues used a large registry of in-hospital cardiac arrest (IHCA) from the American Heart Association's Get with the Guidelines database to examine the characteristics of early cardiac arrest in patients with pre-existing pneumonia. Of 44,416 cardiopulmonary arrest events that occurred within 72 hours of hospital admission that had complete data, 5,367 (12.1 percent) occurred in patients with pre-existing pneumonia. Among those patients with pneumonia, almost 40 percent of cardiac arrests occurred outside of an intensive care unit. Furthermore, at the time of cardiac arrest, only 40 percent of patients with preexisting pneumonia were receiving mechanical ventilation, and 36.3 percent were receiving infusions of vasoactive medications. The distribution of patients with early IHCA was similar in the ICU and in the general ward. Survival was poor for all groups with early in hospital cardiac arrest.
"While our study design precluded definitive analyses of incidence or cause and effect, our main finding was that some patients with pneumonia and cardiac arrest did not appear to experience a premonitory period of overt critical illness," said Dr. Carr. "There appears to be an important group of patients with pneumonia who develop cardiac arrest without respiratory failure or shock."
This is the first large study to report the characteristics of in-hospital cardiopulmonary arrest among patients with pneumonia. The finding that many of these patients are not receiving intensive care or interventions suggests that patients with pneumonia are either more vulnerable than previously thought to abrupt deterioration or that the triage methods used to determine whether a patient is in need of intensive care may be inadequate for patients with pneumonia.
"Decisions about ICU admission may need to be more proactive rather than reactive," Dr. Carr noted. "If we focus our intensive care resources on patients with obvious shock and respiratory failure, we may miss opportunities to intervene on other patients who are at high risk for abrupt deterioration.
"Future studies should investigate the incidence and causes of sudden, early cardiovascular collapse in patients with pneumonia and other forms of sepsis, and address ways to measure and mitigate this risk," he continued. "In the meantime, physicians need to be alert to the possibility of abrupt transitions in these patients."
Finally, Dr. Carr suggested that these findings indicate a need for more research on the different phenotypes of sepsis, of which pneumonia is a major cause. "In recent years we have been lumping these patients into one big group, to facilitate research and the dissemination of care 'bundles'," he said. "In clinical reality, pneumonia and sepsis may be very heterogeneous, and patients who die from these diseases may follow different trajectories. Accordingly, we may need different risk assessment and therapeutic tools for different subgroups."
"In-Hospital Cardiac Arrest Among Patients With Coexisting Pneumonia: A Report From The American Heart Association's Get With The Guidelines - Resuscitation Program" (Session A20, Sunday, May 1, 8:15-10:45 a.m., MDT, Room 102-104-106 (Street Level), Colorado Convention Center; Abstract 22539)
Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Keely Savoie | EurekAlert!
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
Better equipped in the fight against lung cancer
16.05.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.
Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...
A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.
Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
18.05.2018 | Power and Electrical Engineering
18.05.2018 | Information Technology
18.05.2018 | Information Technology