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Original Research: CHEST INFECTIONS |

Early Cardiac Arrest in Patients Hospitalized With PneumoniaEarly Cardiac Arrest in Patients With Pneumonia: A Report From the American Heart Association’s Get With the Guidelines-Resuscitation Program

Gordon E. Carr, MD; Trevor C. Yuen, BA; John F. McConville, MD; John P. Kress, MD, FCCP; Terry L. VandenHoek, MD; Jesse B. Hall, MD, FCCP; Dana P. Edelson, MD; for the American Heart Association's Get With the Guidelines-Resuscitation (National Registry of CPR) Investigators*
Author and Funding Information

From the Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine (Dr Carr), Arizona Health Sciences Center, University of Arizona, Tucson, AZ; the Section of Pulmonary and Critical Care Medicine, Department of Medicine (Drs McConville, Kress, and Hall), and the Section of Hospital Medicine and the Emergency Resuscitation Center (Mr Yuen and Dr Edelson), University of Chicago Medical Center; and the Department of Emergency Medicine (Dr VandenHoek), University of Illinois at Chicago, Chicago, IL.

Correspondence to: Gordon E. Carr, MD, Arizona Health Sciences Center, University of Arizona, 1501 N Campbell Ave, PO Box 245030, Tucson, AZ 85724; e-mail: gcarr@deptofmed.arizona.edu


A complete list of Get With the Guidelines-Resuscitation Investigators is available in e-Appendix 1.

Some data from this study were published in abstract form (Carr GE, Edelson DP, Yuen TC, et al. Am J Respir Crit Care Med. 2011;183:A6339) and presented at the meeting of the American Thoracic Society, Denver, CO, May 13-18, 2011.

Funding/Support: Dr Edelson was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute [Grant K23 HL097157-01].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1528-1536. doi:10.1378/chest.11-1547
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Background:  Pneumonia is the leading infectious cause of death. Early deterioration and death commonly result from progressive sepsis, shock, respiratory failure, and cardiac complications. Recent data suggest that cardiac arrest may also be common, yet few previous studies have addressed this. Accordingly, we sought to characterize early cardiac arrest in patients who are hospitalized with coexisting pneumonia.

Methods:  We performed a retrospective analysis of a multicenter cardiac arrest database, with data from > 500 North American hospitals. We included in-hospital cardiac arrest events that occurred in community-dwelling adults with pneumonia within the first 72 h after hospital admission. We compared patient and event characteristics for patients with and without pneumonia. For patients with pneumonia, we also compared events according to event location.

Results:  We identified 4,453 episodes of early cardiac arrest in patients who were hospitalized with pneumonia. Among patients with preexisting pneumonia, only 36.5% were receiving mechanical ventilation and only 33.3% were receiving infusions of vasoactive drugs prior to cardiac arrest. Only 52.3% of patients on the ward were receiving ECG monitoring prior to cardiac arrest. Shockable rhythms were uncommon in all patients with pneumonia (ventricular tachycardia or fibrillation, 14.8%). Patients on the ward were significantly older than patients in the ICU.

Conclusions:  In patients with preexisting pneumonia, cardiac arrest may occur in the absence of preceding shock or respiratory failure. Physicians should be alert to the possibility of abrupt cardiopulmonary collapse, and future studies should address this possibility. The mechanism may involve myocardial ischemia, a maladaptive response to hypoxia, sepsis-related cardiomyopathy, or other phenomena.

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