Incidence of Cardiac Arrest and Related Factors in a Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study)
Sarinya Chanthawong MD*1, Waraporn Chau-In MD*1, Tanyong Pipanmekaporn MD, PhD*2, Kaweesak Chittawatanarat MD, PhD*3, Suneerat Kongsayreepong MD*4, Nonthida Rojanapithayakorn MD*1, the THAI-SICU study group
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand *2 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *3 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *4 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To describe the incidences, outcomes and determine the risk factor(s) of cardiac arrest in surgical intensive care
unit (SICU).
Material and Method: We collected data between April 2011 and January 2013. The case record form (CRF) included the
CRF 1 (admission, daily screening and discharge data) and the CRF 2 for cardiac arrest events. The patients were followed-
up until discharge from SICU or for up to 28 days after admission in SICU.
Results : The incidence of cardiac arrest in SICU was 226 in 4,652 patients (4.9%). The APACHE II score at the day with
cardiac arrest were 24.1. Initial monitor rhythm during cardiac was asystole (35.4%), bradycardia (22.6%) and pulseless
electrical activity (14.6%). The main cause was poor patient condition before admission (51.3%). Most of the cardiac arrest
patients (73.9%) had antecedents within 24 hour and the most common antecedents were hypotension, metabolic distur-
bances and sepsis and/or septic shock. The overall return of spontaneous circulation rate was 23.5%. At hospital discharge,
the mortality rate (91.6%) was statistically different between the cardiac arrest and non-cardiac arrest group (p<0.001). The
Acute Physiologic and Chronic Health Evaluation II score (APACHE II score) (Odds ratio, (OR 1.15, 95% CI 1.11-1.19,
p<0.001), Sequential Organ Failure Assessment score (SOFA score) (OR 1.12, 95% CI 1.03-1.20, p = 0.005) and American
Society of Anesthesiologists physical status physical status (ASA PS) >3 (OR 2.32, 95% CI 1.33-4.04, p = 0.003) were
significantly risk factors for cardiac arrest.
Conclusion : Cardiac arrest in the SICU was uncommon. Initial non-shockable rhythms were common and mostly had
antecedents before cardiac arrest. The APACHE II score, SOFA score and ASA PS >3 were independent risk factors for
cardiac arrest in SICU.
Keywords : Surgical intensive care unit, Cardiac arrest, Outcomes
