Analysis of Cardiopulmonary Arrested Patients on Arrival Attacked in a Bathroom

Abstract

To clarify problems in the cardio-pulmonary arrest (CPA) cases that occurred in a bathroom, we investigated the medical care and results in 32 cases of CPA (14%) out of the 215 patients carried into our emergency center with CPA from August 2002 to July 2003.
The ages of patients ranged from 43 to 91, indicating a high incidence of CPA in ages over 70 but with no difference between sexes. Most of the cases (21/32, 65.6%) occurred from November to February. Through the exact time of onset was unknown because it was in a bathroom, it took an average of 8.4 minutes from receiving a 119 call until arrival of the ambulance. Average time at the site was 17.4 minutes, and it took an average of 11.0 minutes to transport the patients from the site to the hospital. Out of 32 patients, only six patients (18.8%) received cardiopulmonary resuscitation immediately after the onset. Advanced treatment (mainly airway management) was applied by paramedics on 23 out of 32 patients (71.9%). When carried into the hospital, patients were in CPA and electrocardiogram indicated asystole. Though advanced cardiovascular lifesaving means were applied promptly, most patients (31 cases) were already dead when carried in with one exception whose heartbeats resumed. Causes of onset estimated from clinical findings included 14 drowned, three with subarachnoid hemorrhage, one with trauma, one with aortic disease, one with respiratory disease, and 12 with suspected heart disease and/or unknown causes. In four cases in which subarachnoid hemorrhage or aortic disruption was detected, CT diagnosis clearly indicated that the cause of CPA was an internal disease
It is important to perform a sequence of lifesaving measures consisting of early access, early basic life support, early defibrillation and early advanced cardiovascular life support (ACLS). In the case of onset in a bathroom, in particular, it is highly probable that detection is delayed and that prognosis might be poor. However, it is possible to resuscitate patients with CPA that occurred due to an internal disease without any accompanying lethal influence on the respiratory and circulatory system, so it is important to provide training in cardiopulmonary resuscitation techniques. In addition, prudent bathing is required in winter seasons for the elderly who have some disorders.