Background: Cardiac telemetry was originally designed to help detect and provide early intervention in arrhythmic complications of myocardial infarction. Today, however, telemetry use continues to expand beyond the critical and coronary care units, despite adequate research displaying questionable benefit. Our study seeks to assess the utility of telemetry in identifying decompensation in patients with documented cardiopulmonary arrest.
Methods: We retrospectively reviewed charts on all who experienced a cardiac arrest in our institution between May 1, 2008 and June 30, 2014. We obtained both demographic and clinical information, including reason for admission, patient location and American Heart Association (AHA) indication for telemetry as documented prior to arrest events. We reviewed telemetry records for specific arrhythmic events both 24-hours prior to and immediately preceding cardiac arrest. We analyzed survival and the presence of rhythm changes to our various subclasses of our patient population.
Results: Of 242 arrest patients included in the study, 75 (31.0%) and 110 (45.5%) experienced telemetry changes at the 24-hour and immediately preceding time periods, respectively. Of the telemetry changes, the majority were classified as non-malignant (n=50, 66.7% and n=66, 55.5% at 24-hours prior and immediately preceding, respectively). Subset analysis revealed no difference in telemetry changes between ICU and non-ICU patients, perioperative versus medical admissions and those stratified according to one of the three American Heart Association telemetry indications. There was no difference in survival outcomes when comparing patients with telemetry changes immediately preceding and at 24-hours prior to an event (n=30, 27.3% and n=15, 20.0%) to those without telemetry changes during the same periods (n=27, 20.5% and n=42, 25.2%; p=0.22 and 0.39, respectively).
Conclusions: Telemetry utility is limited in predicting clinical decompensation prior to cardiac arrest in the inpatient setting.