Abstract

Cardiac arrest outcome in septic shock: A national emergency department database study (2016-2018)

Author(s): Sabah Ambreen, Tanveer Mir, Waqas T Qureshi, Tanveer Hussain, Mujeeb Sheikh, Ghulam Saydain

Objective: To study the predictors and morality of cardiac arrest patients presenting to the emergency department who had septic shock.

Background: Literature regarding outcomes of cardiac arrest in patients with septic shock is limited.

Methods: Data from the National Emergency Department Sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments in the United States was analyzed for the septic shock related visits from 2016-2018. Septic shock was defined by the ICD codes.

Results: Out of 1,375,507 adult septic shock patients (mean age 67.09 ± 15.6 years, 48.8% females), cardiac arrest occurred in 112,598 (8.2%) of the patients. Among cardiac arrest patients, 82,595 (73.4%) died till discharge. In multivariable-adjusted logistic regression age >65 years (OR=2.2), prior percutaneous coronary intervention (OR 1.2), prior-coronary artery bypass graft (OR=1.26) and peripheral vascular disease (OR=1.3) were associated with mortality and coronary interventions (OR=0.3), shockable rhythm R=0.8), congestive heart failure (OR=0.6) were not associated with mortality (p<0.001). The results were consistent after propensity matching. However, the trend for coronary interventions was steady over study years. Cardiac arrest patients had a longer hospital stay and cardiac arrhythmias had a significant association with longer hospital stay. Cardiac arrest prevalence and survival trends were steady over the study years, 2016-2018.

Conclusion: Cardiac arrest complicated septic shock significantly with high mortality. Coronary interventions were associated with improved survival rates. More research is needed to improve mortality associated with cardiac arrest in patients with septic shock.