Assess the prearrest risk factors among patients with in hospital cardiac arrest in a tertiary care teaching hospital

This study focused on the prearrest risk factors among patients with in hospital cardiac arrest. This was a prospective study with 50 cardiac arrest patients who ful(cid:976)illed the inclusion criteria by using a purposive sampling technique. Data was collected on patient characteristics, pre-arrest factors with 18 years of age or above with an IHCA at the SRM General Hospital and Research Centre, Tamil Nadu from March 2019 to March 2020. Demographic variables catego-rized by frequencies with their percentages. Association was framed between demographic variables and Prearrest risk score was determined using pearson chisquare test. 72% patients were men and 28% patients were women. 28% were in the age group of 51-60 years and around 50% patients were Obese. Patients with Myocardial Infarction were 84%. Metabolic and electrolyte abnormality were 90%, Arrhythmias were 62%, Diabetes Mellitus were 62% had an increased risk score to develop cardiac arrest than other patients with Renal problems, Heart failure, Sepsis, Pneumonia, Metastasis/ Hematologic Malignancy, Depression, Hepatic Insuf(cid:976)iciency. Early identi(cid:976)ica-tion of prearrest factors should be encouraged to prevent cardiac arrest and to reduce the death rate in line with evidence-based studies.

In Hospital Cardiac Arrest, Prearrest factors, Pre-existing clinical conditions, Tertiary care A This study focused on the prearrest risk factors among patients with in hospital cardiac arrest. This was a prospective study with 50 cardiac arrest patients who ful illed the inclusion criteria by using a purposive sampling technique. Data was collected on patient characteristics, pre-arrest factors with 18 years of age or above with an IHCA at the SRM General Hospital and Research Centre, Tamil Nadu from March 2019 to March 2020. Demographic variables categorized by frequencies with their percentages. Association was framed between demographic variables and Prearrest risk score was determined using pearson chisquare test. 72% patients were men and 28% patients were women. 28% were in the age group of 51-60 years and around 50% patients were Obese. Patients with Myocardial Infarction were 84%. Metabolic and electrolyte abnormality were 90%, Arrhythmias were 62%, Diabetes Mellitus were 62% had an increased risk score to develop cardiac arrest than other patients with Renal problems, Heart failure, Sepsis, Pneumonia, Metastasis/ Hematologic Malignancy, Depression, Hepatic Insuf iciency. Early identi ication of prearrest factors should be encouraged to prevent cardiac arrest and to reduce the death rate in line with evidence-based studies.

INTRODUCTION
Utstein de inition stated that cardiac arrest is a sudden stoppage of cardiac function that is absent pulse, absent or gasping breath and loss of consciousness (Sandroni et al., 2007). This study describes the basic characteristics, pre-arrest factors of patients with an IHCA at a tertiary care hospital.
Major research studies and meta analysis of rapid response systems in 41 hospitals described the occurrences of IHCA outside ICU's is 3.66 /1000 adult admissions and 1.14 per 1000 pediatric admissions (Chan et al., 2010).
Cardiac arrest researches and cardiopulmonary resuscitation (CPR) has drastically increased in recent decades. Therefore, we sought to determine prearrest factors of an adult in patients with cardiac arrest at a tertiary hospital. (Ocen et al., 2015). Single-institution studies by using Utstein criteria have reported outsized variations in the incidence rates of adult IHCA, ranging from 3.8 to 13.1 per 1000 hospital admissions (Hodgetts et al., 2002;Motamedi et al., 2010).

MATERIALS AND METHODS
This was a prospective study. Data was collected from 50 In Hospital cardiac arrest patients who ful illed the inclusion criteria by using purposive sampling technique. Data was collected on patient characteristics, pre-arrest factors with 18 years of age or above with an IHCA at the SRM General Hospital and Research Centre, Tamilnadu from March 2019 to March 2020. Demographic variables in categories were given in frequencies with their percentages. Prearrest risk score determined by mean and standard deviation.Association was framed between demographic variables and level of Prearrest risk score by using pearson chisquare test. Generalization of Prearrest risk score was calculated by using mean difference with 95% CI and proportion with 95% CI. All statistical tests are two tailed tests.  Two third of the patients (64%) were between 201-500 mmHg Triglycerides Level. The incidence of cardiac arrest parallels the load of cardiovascular illnesses, with cardiac arrest as the ground of death in >60% of patients with known coronary artery disease (Murugiah et al., 2014).     was considered to be the most common diagnosis (58 %) with 76.9 percent of all trauma cases were severe head injuries. Following Trauma, conditions like sepsis, heart disease, central nervous system disease, diabetes mellitus, hypertension and liver disease increases the chance of IHCA. Comorbidity illness was registered in 62 patients. HIV infection, hypertension, cancer, diabetes mellitus, kidney, liver and CNS diseases constituted 45, 22, 14, 13, 2, 2, and 2 %, respectively (Ocen et al., 2015). Table 4 : shows that obese patients had an increased risk score than others. Diabetic treatment taking patients had an increased risk score than others. Patients taking sleep less than 6 hours had an increased risk score than others. Drinking habit patients had an increased risk score than oth-ers. Statistical signi icance was calculated using chi square test.

DISCUSSION
Prospective study to assess the prearrest risk factors among patients with in hospital cardiac arrest was conducted. Compared with many literatures, our hospital has moderate incidence of IHCA. The prevalence rate was higher than previously reported rates of 1-6 cardiac arrests per 1000 hospital admis-sions (Motamedi et al., 2010;Chakravarthy et al., 2012). Circadian variation in cardiopulmonary arrest of in-hospital patients affects the survival to discharge It is noted that there is a need for an adequate patient monitoring system to distinguish those at risk of in hospital cardiac arrest (Jones-Crawford et al., 2007).
The death of ICU's in low-income hospital has been well documented in numerous studies (Kwizera et al., 2012;Cox et al., 2012;Vincent et al., 2014). The interventions to improve an outcome that is early identi ication of IHCA and timely initiation of CPR also cost the smallest amount to Hospitals (Adhikari, 2013). In this study, we also noted that, a lack of identi ication with regards to the detection of pre-existing conditions and risk factors related to cardiac arrest.This contributed to the importance of conducting this study.
In most studies, most of the patients were young adults of age less than 50 years (Sandroni et al., 2007;Bonnin et al., 1993). In addition, the most of our patients were mainly young males. Our study was equivalent with preceding reports that most of males are cardiac arrest patients in the ICU (Kutsogiannis et al., 2011). The most common connected diagnoses in this study were Myocardial Infarction 42(84%), Metabolic and electrolyte abnormality 45(90%), Arrythmias 31(62%), Diabetes Mellitus 31(62%) are having more increased risk score to develop cardiac arrest than other patients with Renal problems, Heart failure, Sepsis, Pneumonia, Metastasis/ Hematologic Malignancy" Depression, Hepatic Insuf iciency, Stroke.
Demographic variables were given in frequencies with their percentages. Prearrest risk score was given in mean and standard deviation. Association between demographic variables and level of Prearrest risk score was determined using pearson chisquare test. Generalization of Prearrest risk score was analyzed using and mean difference with 95% CI and proportion with 95% CI. Simple bar diagram represents the data. P<0.05 was considered statistically signi icant. All statistical tests were twotailed tests

CONCLUSIONS
Early recognition and identi ication of warning signs of cardiac arrest may facilitate the hospital for treatment and prevent patient deterioration. All tertiary hospitals should be encouraged to provide patient care with resuscitation services and decrease the death rate that occurs out of cardiac illness.

ACKNOWLEDGEMENT
This study is part of Ms. A,Akila Devi's Ph.D study. Dr. Sunderesan., Ph.D is a guide and Dr. C. Kanniammal., Dean is the HOD of the Department of Nursing who has assisted in the progression of this research project.

Authors contribution
Author prepared the problem statement by reviewing the published articles and received the institutional ethical committee clearance. Obtained formal approval from hospital before author involved in data collection. Data was completely analyzed by the author with the help of statistician to meet the objectives.