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Cardiac arrest in the intensive care unit: An assessment of preventability

Resuscitation Sep 20, 2019

Moskowitz A, Berg KM, Cocchi MN, et al. - As in the intensive care unit (ICU), cardiac arrest (CA) occurs commonly and is a highly morbid event, researchers investigated its preventability and sought for targets for future intervention. In this observational study, they included 43 patients who experienced an ICU-CA at a tertiary care center in the United States. As per observations, ICU-CAs may have preventable elements. The expert panel and survey respondents identified unlikely but potentially preventable arrests, which were 14 (32.6%) and 13 (30.2%), respectively, and in addition, 11 (25.6%) and 10 (23.3%) arrests were identified as potentially preventable. Contributors to potential preventability, which were most commonly cited, were timing of the response to clinical deterioration, missed/incorrect diagnosis, the timing of acidemia correction, timing of escalation to a more senior clinician, and timing of intubation. Additional themes recognized were the use of anxiolytics/narcotics for agitation later recognized to be because of clinical deterioration and misalignment between team and patient/family perceptions of prognosis and goals-of-care. They suggest undertaking data-driven quality improvement initiatives to potentially decrease CA incidence in critically-ill patients.
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