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Patients with pneumonia at increased risk for early cardiac arrest

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Patients hospitalized for pneumonia may be at increased risk for early cardiac arrest and may present with little or no warning symptoms, according to data presented at the American Thoracic Society 2011 International Conference.

“We found a compelling signal that some patients with pneumonia may develop cardiac arrest outside of the intensive care unit, without apparent shock or respiratory failure,” Gordon Carr, MD, pulmonary and critical care fellow at the University of Chicago Medical Center, said in a press release. “If this is true, then we need to improve how we assess risk in pneumonia.”

Carr and colleagues pooled data from the American Heart Association’s Get with the Guidelines database among 44,416 in-hospital cardiopulmonary arrest cases who went into early cardiac arrest within 72 hours of hospital admission. Of these, 5,367 patients had pre-existing pneumonia. The median time from hospital admission to in-hospital cardiopulmonary arrest was 20.7 hours.

Of these patients, 77.2% of cardiac arrests occurred in an ICU step-down unit, and 19.3% occurred in the general patient area. At the time of cardiac arrest, only 40% of patients with pre-existing pneumonia received mechanical ventilation, and 36.3% received infusions of vasoactive therapies, according to the study abstract.

Causes of in-hospital cardiopulmonary arrest included arrhythmia (65%), respiratory insufficiency (53.9%) and hypotension/hypoperfusion (49.8%).

“While our study design precluded definitive analyses of incidence or cause and effect, our main finding was that some patients with pneumonia and cardiac arrest did not appear to experience a premonitory period of overt critical illness,” Carr said. “There appears to be an important group of patients with pneumonia who develop cardiac arrest without respiratory failure or shock.”

Carr said future studies should “examine the incidence and cause of sudden, early cardiovascular collapse in patients with pneumonia and other forms of sepsis, and address ways to measure and mitigate this risk. In the meantime, physicians need to be alert to the possibility of abrupt transitions in these patients.”

Disclosure: Dr. Carr reports no relevant financial disclosures.