Unexpected cardiac arrest in the neurosurgical ward

Objective: This study aimed to identify possible predictors of unexpected cardiac arrest (CA) in the neurosurgical ward.Methods: A retrospective review of 24 patients who experienced unexpected CA between December 2012 and March 2022 was conducted. Data on demographics, diagnoses, comorbidities, CA timing, pre-CA vital signs, transfer interval from intensive care unit (ICU) to ward, cardiac rhythm, neurological outcomes, and probable causes were collected. We excluded patients who died in the ICU and those with a do-not-resuscitate order.Results: The average age was 70.3 years. Vascular diseases and head traumas were common diagnoses. About 70.8% of arrests occurred during on-call time and 62.5% took place on weekends. The mean interval between ICU transfer and CA was 13.8±29.7 days, with 54.2% occurring within 4 days and 83.3% within 14 days. Pulseless electrical activity was the most frequent initial cardiac rhythm when CA occurred. Respiratory issues were the leading cause of CA (54.2%), and 91.7% of patients had poor neurological outcomes. Within 48 hours before CA, the average value of the lowest arterial oxygen saturation significantly deteriorated from 95.8±2.9% to 90.1±11.4%.Conclusion: Unexpected CA often occurred on weekends and during night duty. Half of the cases took place within 4 days and over 80% within 2 weeks of transferring from the ICU to the ward, with respiratory problems being the main cause. Greater attention should be given to patients’ breathing patterns during night shifts and weekends, especially within the first 2 weeks after patients leave the ICU.