The Duty to Monitor for Cardiac or Respiratory Arrest

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A sudden cardiac or respiratory arrest is often unanticipated and devastating.  For many who suffer these events while at home, work, or elsewhere, by the time emergency medical help arrives it is late to avoid death or life long disability.  But, when a patient suffers a cardiac or respiratory arrest in the hospital, help should be just seconds away.

Many factors increase the likelihood of cardiac or respiratory arrest in hospitalized patients.  Patients recovering from illness or surgery may be more prone to suffer cardiac or respiratory arrest, especially if they have pre-existing cardiac or respiratory disease.

As many as 10 million adults suffer a major cardiac complication in the first 30 days after non-cardiac surgery each year, and cardiac complications are the leading cause of postoperative deaths. [1]  For example, patients with preexisting, chronic cardiac conditions who undergo elective surgery may have an increased risk of developing a potentially fatal clot, or thrombus, in a coronary artery.  Acute trauma or an interruption in antiplatelet medication also increases the likelihood of acute cardiac event.

Many hospitalized patients receive pain medications known as opioids which can increase the risk of a deadly cardiac or pulmonary event.   And, patients with diagnosed or undiagnosed obstructive sleep apnea are at higher risk of postoperative complications, including respiratory depression and cardiac arrest.

Doctors and hospitals must assure proper monitoring of patients who by reason of medical or surgical history are more susceptible to suffer cardiac arrest or respiratory arrest.  Yet, often patients who require careful cardiac or respiratory monitoring are assigned to hospital units where continuous EKG or pulse oxygen monitoring simply is not part of the protocol.

Fortunately, many patients who require close monitoring of their heart rhythm or blood oxygen saturation are attached to an EKG or pulse oximeter.  However, patients like these who are in the hospital and attached to a heart or oxygen saturation monitor should never suffer an unwitnessed cardiac arrest.  Yet, too often we hear stories of patients who are “found” unresponsive.  The first question we ask is “what happened to the alarm?”.

[1] Devereaux, P.J, Sessler, D.I., Cardiac Complications in Patients Undergoing Noncardiac Surgery, N. Engl. J. Med. 2015; 373:2258-69.

To learn more about why some patients attached to monitors fail to receive the emergency care necessary to save their lives in the face of sudden cardiac or respiratory arrest, read Failure to Rescue from Cardiac or Respiratory Arrest.

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