Outcomes after cardiac arrest in an adult burn center

Jonathan C. Wilton, Mark O. Hardin, John D. Ritchie, Kevin K. Chung, James K. Aden, Leopoldo C. Cancio, Steven Wolf, Christopher E. White

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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 in-hospital 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. Further, those who experience multiple CA are unlikely to survive to discharge002E.

Original languageEnglish (US)
Pages (from-to)1541-1546
Number of pages6
JournalBurns
Volume39
Issue number8
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Fingerprint

Burn Units
Heart Arrest
Cardiopulmonary Resuscitation
Population
Intensive Care Units
Resuscitation Orders
Afghanistan
Iraq
Incidence
Operating Rooms
Respiratory Insufficiency

Keywords

  • Burn patients
  • Cardiopulmonary resuscitation
  • In-hospital cardiac arrest
  • Thermal injury

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Wilton, J. C., Hardin, M. O., Ritchie, J. D., Chung, K. K., Aden, J. K., Cancio, L. C., ... White, C. E. (2013). Outcomes after cardiac arrest in an adult burn center. Burns, 39(8), 1541-1546. https://doi.org/10.1016/j.burns.2013.08.005

Outcomes after cardiac arrest in an adult burn center. / Wilton, Jonathan C.; Hardin, Mark O.; Ritchie, John D.; Chung, Kevin K.; Aden, James K.; Cancio, Leopoldo C.; Wolf, Steven; White, Christopher E.

In: Burns, Vol. 39, No. 8, 01.12.2013, p. 1541-1546.

Research output: Contribution to journalArticle

Wilton, JC, Hardin, MO, Ritchie, JD, Chung, KK, Aden, JK, Cancio, LC, Wolf, S & White, CE 2013, 'Outcomes after cardiac arrest in an adult burn center', Burns, vol. 39, no. 8, pp. 1541-1546. https://doi.org/10.1016/j.burns.2013.08.005
Wilton JC, Hardin MO, Ritchie JD, Chung KK, Aden JK, Cancio LC et al. Outcomes after cardiac arrest in an adult burn center. Burns. 2013 Dec 1;39(8):1541-1546. https://doi.org/10.1016/j.burns.2013.08.005
Wilton, Jonathan C. ; Hardin, Mark O. ; Ritchie, John D. ; Chung, Kevin K. ; Aden, James K. ; Cancio, Leopoldo C. ; Wolf, Steven ; White, Christopher E. / Outcomes after cardiac arrest in an adult burn center. In: Burns. 2013 ; Vol. 39, No. 8. pp. 1541-1546.
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abstract = "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 in-hospital 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. Further, those who experience multiple CA are unlikely to survive to discharge002E.",
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AU - Hardin, Mark O.

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AU - Chung, Kevin K.

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AU - Cancio, Leopoldo C.

AU - Wolf, Steven

AU - White, Christopher E.

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N2 - 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 in-hospital 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. Further, those who experience multiple CA are unlikely to survive to discharge002E.

AB - 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 in-hospital 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. Further, those who experience multiple CA are unlikely to survive to discharge002E.

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KW - Thermal injury

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