Objective: To identify the predicting factors associated with the occurrence of cardiac arrest in an emergency department (ED).

Materials and Methods: The present research was a retrospective study of all non-traumatic ED patients assigned to emergency severity index (ESI) level 1 (critical), level 2 (emergency), and level 3 (urgency) between August 1, 2014 and July 31, 2016. The primary outcome was the differentiation of predicting factors between cardiac arrest patients and non-cardiac arrest patients for occurrence of cardiac arrest in an ED.

Results: Four hundred eighty patients were enrolled. The factors found to have a significant association (p<0.05) in the non-cardiac arrest group versus the cardiac arrest group at the ED were systolic blood pressure (SBP), oxygen saturation (SpO₂), Glasgow coma scale score, normal sinus rhythm, sinus tachycardia, serum pH, serum lactate level, and the modified early warning score (MEWS). A multivariate analysis was then performed. After adjusting for multiple factors, ESI level 2 patients were more likely to have cardiac arrest in the ED compared with ESI level 1 (adjusted odds ratio [ORadj] 1.66, 95% confidence interval [CI] 0.82 to 3.37). Furthermore, ESI level 2 patients were more likely than ESI level 1 patients to have cardiovascular disease (ORadj 1.89, 95% CI 0.87 to 4.11), heart rate lower than 55 beat/minute (ORadj 6.83, 95% CI 2.14 to 21.83), SBP lower than or equal to 90 mmHg (ORadj 3.41, 95% CI 1.53 to 7.56), SpO₂ lower than 94% (ORadj 4.76, 95% CI 2.29 to 9.91), sinus tachycardia (ORadj 4.32, 95% CI 1.77 to 10.51), serum lactate greater than 4 mmol/L (ORadj 10.66, 95% CI 3.68 to 30.87), and MEWS more than 4 (ORadj 4.86, 95% CI 2.44 to 9.67). These factors remained predictive of cardiac arrest at the ED.

Conclusion: The factors related to cardiac arrest in the ED are ESI level 1 and level 2 patients, cardiovascular diseases, SpO₂ lower than 94%, serum lactate level greater than 4 mmol/L, and MEWS more than 4. These factors can be used as an ED’s triage and markers to identify the patients who might have a tendency to develop cardiac arrest.

Keywords: Cardiac arrest, Predicting factor, Emergency department

Received 22 Jun 2018 | Revised 13 Nov 2018 | Accepted 16 Nov 2018