Cardiac Arrest Aetiologies and Outcomes in Ward Areas: A Retrospective Study of 5H\'s and 5T\'s

Introduction:The average incidence of in-hospital cardiac arrest (IHCA) is around 6.9 per 1,000 admissions, ranging from 1.0 to 22.9 per 1,000 admissions, with a survival rate of 20%.The common causes are the 5H's and 5T's, and all resuscitation guidelines revolve around treating these causes.Interestingly, patients can have a cardiac arrest despite normal 5H's and 5T's.Routine post-arrest care predominantly focuses on supportive measures and reversing the 5H's and 5T's.Despite these measures, the mortality rate remains high.This highlights an area of research where newer modalities like Deep early warning system, deep-learning-based artificial intelligence model using 12-lead ECG may be needed to reduce mortality.Methodology: A retrospective observational study.All IHCAs that occurred in ward areas (excluding intensive care unit (ICU) and emergency departments) were included in the study.Data were collected from electronic medical records and analysed retrospectively.Cardiac arrest sheets completed during resuscitation, along with issues encountered and events leading to arrest, were reviewed after each case.All discussions, including corrective and preventive actions documented, were included in the study.Outcome: The average duration of resuscitation was approximately 15 minutes (around seven cycles), with return of spontaneous circulation (ROSC) achieved in 69.28% of patients.The most common cause of arrest was hypoxia secondary to aspiration, followed by underlying cardiac disease precipitating arrest.Interestingly, 36.73% of patients were arrested without probable cause.Sodium bicarbonate was used in 53% of resuscitations, and its role in revival appeared significant.All patients continued to receive supportive care such as ventilation, vasopressors, and targeted temperature management.Forty-four percent of patients developed severe acidosis requiring sodium bicarbonate infusion or continuous renal replacement therapy (CRRT) post-ROSC.The average duration of survival post-cardiac arrest was 2 days, with most patients succumbing to their illness.Complete recovery and discharge occurred in only 6 out of 34 patients (17.64%).Conclusion: The 5H's and 5T's may not be the only causes of cardiac arrest.These parameters are generally deranged after arrest, and addressing them helps restore cardiac activity.Supportive care plays a key role in keeping patients alive, but many fail to sustain due to multi-organ dysfunction syndrome (MODS) caused by circulatory failure.This may represent an area for further research.Newer modalities like Deep early warning system, deep-learning-based artificial intelligence model using 12-lead ECG appear promising but face many limitations, including restricted availability and a lack of clear guidelines.