Polypharmacy prior to in-hospital cardiac arrest among patients with cardiopulmonary diseases: A pilot study

BACKGROUND: Patterns of medication administration prior to in-hospital cardiac arrest (I-HCA) and the potential impact of these on patient outcomes is not well-established. Accordingly, types of medications administered in the 72 ​h prior to I-HCA were examined in relation to initial rhythms of I-HCA and survival. METHODS: A retrospective, pilot study was conducted among 96 patients who experienced I-HCA. Clinical characteristics and treatments including medications were extracted from electronic health records. Relative risk (RR) of medications or class of medications associated with the initial rhythms of I-HCA and return of spontaneous circulation (ROSC) were calculated. RESULTS: Two distinct sub-groups were identified that did not survive to hospital discharge (n ​= ​31): 1) those who received either vasopressin/ desmopressin (n ​= ​16) and 2) those who received combinations of psychotherapeutic agents with anxiolytics, sedatives, and hypnotics (n ​= ​15) prior to I-HCA. The risk of pulseless electrical activity and asystolic arrest was high in patients who received sympathomimetic agents alone or in combination with β-Adrenergic blocking agents, (RR ​= ​1.40, 1.41, respectively). Vasopressin and a combination of vasopressin and fentanyl were associated with risk of unsuccessful ROSC (RR ​= ​2.50, 2.38, respectively). CONCLUSIONS: The types of medications administered during inpatient care may serve as a surrogate marker for identifying patients at risk of specific initial rhythms of I-HCA and survival.