Top

Environmental Health and Preventive Medicine

Published in:

01-03-2013 | Regular Article

Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles

Authors: Joji Inamasu, Satoru Miyatake

Published in: Environmental Health and Preventive Medicine | Issue 2/2013

Abstract

Objectives

The great majority of non-traumatic cardiac arrests (CA) occur at home. The toilet is a closed and private room where CA occurs frequently. However, due to the feelings of privacy that are associated with this room, the circumstances and causes of CA in the toilet have rarely been investigated.

Methods

A retrospective study was conducted to clarify clinical characteristics and resuscitation profiles of patients sustaining CA in the toilet.

Results

Among 907 CA patients treated during a 4-year period, 101 (11 %) sustained CA in the toilet. While the collapse was witnessed in only 10 % of these patients, return of spontaneous circulation (ROSC) was achieved in 41 %. However, the long-term survival rate was 1 %. Multivariate regression analysis revealed that a history of cardiac diseases was predictive of CA in the toilet (odds ratio 3.045; 95 % confidence interval 1.756–5.282) but that there was no correlation with advanced age. The frequency of CA in the toilet may be influenced moderately by seasonal/circadian variations. The 101 patients were classified into four subgroups according to mode of discovery of CA. The frequency of ROSC was highest in those who collapsed in the presence of caregivers and lowest in those whose collapse were discovered later by family members being worried that the patient stayed in the toilet “too long.” Imaging studies revealed life-threatening extra-cardiac lesions responsible for CA, such as subarachnoid hemorrhage and aortic dissection, in 23 % of the patient cohort.

Conclusions

The rarity of long-term survival among individuals sustaining CA in the toilet is mainly due to the delay in discovering the individual who collapsed. Although a history of cardiac diseases is a risk factor, predicting who may sustain CA in the toilet remains difficult due to etiological heterogeneity.

Folke F, Gislason GH, Lippert FK, Nielsen SL, Weeke P, Hansen ML, et al. Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation. Circulation. 2010;122:623–30.PubMedCrossRef

Hayashi S, Toyoshima H, Tanabe N, Satoh T, Miyanishi K, Seki N, et al. Activity immediately before the onset of non-fatal myocardial infarction and sudden cardiac death. Jpn Circ J. 1996;60:947–53.PubMedCrossRef

Matoba R, Shikata I, Iwai K, Onishi S, Fujitani N, Yoshida K, et al. An epidemiologic and histopathological study of sudden cardiac death in Osaka Medical Examiner’s Office. Jpn Circ J. 1989;53:1581–8.PubMedCrossRef

Shigeomi S, Sato W, Enzan K, Yoshioka N. Sudden death during bathing in the elderly. J Jpn Assoc Acute Med. 2001;12:109–20.

International Liaison Committee on Resuscitation. International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: advanced life support. Resuscitation. 2005;67:213–47.CrossRef

Langhelle A, Nolan J, Herlitz J, Castren M, Wenzel V, Soreide E, et al. Utstein consensus symposium. Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style. Resuscitation. 2003;205(66):271–83.

Monro A, Mulley GP. Hospital bathrooms and showers: a continuing saga of inadequacy. J R Soc Med. 2004;97:235–7.PubMedCrossRef

Arntz HR, Willich SN, Schreiber C, Brüggemann T, Stern R, Schultheiss HP. Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases. Eur Heart J. 2000;21:315–20.PubMedCrossRef

Peckova M, Fahrenbruch CE, Cobb LA, Hallstrom AP. Circadian variations in the occurrence of cardiac arrests: initial and repeat episodes. Circulation. 1998;98:31–9.PubMedCrossRef

10.

Matsuda M, Watanabe K, Saito A, Matsumura K, Ichikawa M. Circumstances, activities, and events precipitating aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2007;16:25–9.PubMedCrossRef

11.

Inamasu J, Miyatake S, Tomioka H, Suzuki M, Nakatsukasa M, Maeda N, et al. Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study. Resuscitation. 2009;80:977–80.PubMedCrossRef

12.

Kojima S, Sumiyoshi M, Nakata Y, Daida H. Triggers and circadian distribution of the onset of acute aortic dissection. Circ J. 2002;66:232–5.PubMedCrossRef

13.

Yamada N, Nakamura M, Ishikura K, Ota M, Yazu T, Ota S, et al. Triggers of acute pulmonary thromboembolism developed in hospital, with focusing on toilet activities as triggering acts. Int J Cardiol. 2005;98:409–11.PubMedCrossRef

14.

Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008;76:198–206.PubMedCrossRef

15.

Kapoor WN, Peterson J, Karpf M. Defecation syncope. A symptom with multiple etiologies. Arch Intern Med. 1986;146:2377–9.PubMedCrossRef

16.

Culić V. Triggering of cardiovascular incidents by micturition and defecation. Int J Cardiol. 2006;109:277–9.PubMedCrossRef

17.

Sikirov BA. Cardio-vascular events at defecation: are they unavoidable? Med Hypotheses. 1990;32:231–3.PubMedCrossRef

18.

Allan L, Johns E, Doshi M, Anne Kenny R, Newton JL. Abnormalities of sympathetic and parasympathetic autonomic function in subjects with defaecation syncope. Europace. 2004;6:192–8.PubMedCrossRef

19.

Komatsu K, Sumiyoshi M, Abe H, Kohno R, Hayashi H, Sekita G, et al. Clinical characteristics of defecation syncope compared with micturition syncope. Circ J. 2010;74:307–11.PubMedCrossRef

20.

Hadjis NS, McAuley GJ, Ruo L, Kwauk S, Olatunbosun F. Acute abdominal pain and urgency to defecate in the young and the old: a useful symptom-complex? J Emerg Med. 1999;17:239–42.PubMedCrossRef

Title: Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles
Authors: Joji Inamasu
Satoru Miyatake
Publication date: 01-03-2013
Publisher: Springer Japan
Published in: Environmental Health and Preventive Medicine / Issue 2/2013
Print ISSN: 1342-078X
Electronic ISSN: 1347-4715
DOI: https://doi.org/10.1007/s12199-012-0301-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2013

Maternal and paternal family history of type 2 diabetes differently influence lipid parameters in young nondiabetic Japanese women

P.R4810K, a polymorphism of RNF213, the susceptibility gene for moyamoya disease, is associated with blood pressure

Abnormality of risk factors for atherosclerotic disease among young Japanese aged 19–39 years old: an evaluation of health checkup data

Association of genotypes of carcinogen-metabolizing enzymes and smoking status with bladder cancer in a Japanese population

Workers' load and job-related stress after a reform and work system change in a hospital kitchen in Japan

Tobacco use and impact of tobacco-free policy on university employees in an environment of high tobacco use and production