Cardiac arrest in hospital patients for pneumonia usually occurs suddenly and outside the intensive care unit, where necessary medical measures could save the patient's life - these results were presented at the annual conference of the American Thoracic Society, held in Denver, Colorado (United States). Patients diagnosed with pneumonia are at increased risk of developing sudden cardiac arrest. However, most experts believe that such a condition only develops after a progressive deterioration of the condition, accompanied by many "alarming" symptoms.

In the classic version of the course of events (that is, when the patient's condition progressively worsens), a healthy person develops pneumonia or other potentially fatal infectious disease, the course of which is accompanied thereafter a number of easily recognizable syndromes. The above syndromes include: a systemic inflammatory response syndrome, followed by organic failure, hemodynamic failure, and multiple failure. As a rule, cardiac arrest develops as the end result of hemodynamic failure, kidney failure and severe metabolic disorders. But some concern is caused by the category of patients in whom, bypassing the above "logical chain" of clinical syndromes, worsening of the condition occurs strongly.

The main task of the researchers was to reveal the mechanisms of the rapid development of cardiac arrest in patients diagnosed with pneumonia in order to review the monitoring strategy for this category of patients.

A number of questions naturally arise: do patients with a compensated course of an infectious disease really have no other "alarming" clinical syndromes, and is there really an unexpected development of a acute cardiopulmonary insufficiency in the context of compensation for the underlying disease.

Most pulmonologists have encountered similar clinical cases in practice. However, to date, there is not enough data to attest that this is actually happening.

In the first large-scale study, which described and documented the characteristics of cardiac arrest in patients diagnosed with pneumonia, the research team worked with the American Heart Disease Association. During this study, recommendations developed on the basis of the resuscitation database - a large multicenter register of adult patients hospitalized for cardiac arrest in more than 500 medical establishments (formerly known as the "National Cardio Resuscitation Register -respiratory ”) have been actively used.

A total of 44,416 cases of cardiac arrest occurred within 72 hours of hospitalization. Pneumonia as a previous condition was recorded in 5367 cases (12.1%).

In approximately 40% of patients, cardiac arrest has occurred outside of intensive care. In addition, only 40% of pneumonia patients underwent mechanical ventilation, 12% had a central venous catheter in place and 36% had a continuous IV infusion of vasoactive drugs.

The most common immediate causes of cardiac arrest in patients with pneumonia were arrhythmia (65.0%), respiratory failure (53.9%) and hypotension / hypoperfusion (49.8%). ).

During the analysis of the study results, a significant proportion of patients diagnosed with pneumonia were identified, who then suffered sudden cardiac arrest. It was found that 56% of cardiac arrest cases did not occur due to hypotension or that hypotension preceded cardiac arrest, and about 40% occurred outside of intensive care.

The data obtained indicate the need for further research aimed at finding methods to rapidly assess the risk of developing cardiac arrest in patients diagnosed with "pneumonia" in practice. In addition, information on the incidence and etiology of this syndrome will be extremely important and necessary.

According to the researchers, it is necessary to carefully review not only the assessment of the degree of risk, but also the calculation of the time required to complete the total amount of medical procedures necessary for the patient.

Several experts have questions about the results of the study. So the question of the number of patients who had a cardiovascular pathology, which was not diagnosed or diagnosed but underestimated, makes perfect sense? In the study presented, no in-depth analysis of the concomitant cardiovascular pathology (coronary artery disease, heart failure, hypertension, cardiac pathology in diabetes mellitus, etc.) was carried out.

In addition, the fact that 20% of patients in the high-risk group were in general services, where the number of medical personnel and the intensity of follow-up of severe patients was much less surprising. Consequently, the distribution of patients in the departments at the time of their hospitalization does not occur correctly.

Here are a number of other questions that arise regularly. Are there a significant number of patients with cardiovascular pathology not previously detected in this group? Is it possible that the antibacterial drugs used to treat pneumonia cause heart rhythm disturbances? Is it possible that, in the general service of the hospital, the low oxygen concentrations in the blood have not been adjusted medically adequately? A more in-depth retrospective analysis of the amount of information obtained during the study will answer all the questions that have arisen.

In addition, the fact that the leading cause of cardiac arrest in this patient category was arrhythmia was remarkable.

And if arrhythmia is actually the most common cause of cardiac arrest, then oxygen supply, sufficient electrolyte saturation, and replacement of proarrhythmic drugs with others that do not have these properties, patients to high risk can play a decisive role in preventing the development of sudden cardiac arrest.