Association between Shock Index and Emergency Department Cardiac Arrest

Chao-Tung Chen; Pei-Ming Wang; Chao-Hsin Wu; Chih-Wei Wei; Tai-Lin Huang

doi:10.1155/2021/9138449

Association between Shock Index and Emergency Department Cardiac Arrest

Emerg Med Int. 2021 Oct 25:2021:9138449. doi: 10.1155/2021/9138449. eCollection 2021.

Authors

Chao-Tung Chen¹, Pei-Ming Wang¹, Chao-Hsin Wu², Chih-Wei Wei², Tai-Lin Huang²

Affiliations

¹ Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Emergency Center of Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.

Abstract

Background: In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED.

Methods: Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems.

Results: In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5-1.8). The aOR (CI) in the five etiologies was 1.3 (1.1-1.6) for hypoxia, 1.8 (1.6-2.1) for cardiac cause, 1.3 (0.98-1.7) for bleeding, 1.3 (1.03-1.6) for sepsis, and 1.9 (1.5-2.1) for other metabolic problems.

Conclusion: More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.