Background: Despite resuscitative efforts, cardiac arrest (CA) continues to result in high mortality and poor prognosis. However, a gap remains in understanding the comparative outcomes of efforts in emergency departments (ED) over recent years. This study evaluated patients with CA during ED visits, with a particular focus on outcomes of mortality and transition of care. Methods: We conducted a retrospective cohort analysis using the National Emergency Department Sample (NEDS) database. The study population included patients aged 18 years or older who visited the ED between January 2016 and December 2020. Statistical analysis of patients and hospital characteristics included chi-squared tests for independence and multivariable logistic regression models to report the associations of factors with mortality in the ED and disposition from the ED. The primary outcome measured was mortality in the ED, and the secondary outcome included transition of care. Results: A total of 699,822,424 ED visits occurred between 2016 and 2020, with 1,414,060 (0.20%) CAs. The survival rate from CA ranged from 24.6% to 28.1%. In 2020, the rate of ED CA increased to 0.27%, with an inpatient mortality rate of 58.8%. There was no significant difference in mortality between sexes (p = 0.690). There was a trend for higher mortality in the ED among patients who were self-paid. Notably, the odds of transfer from the ED to other hospitals were significantly lower in minority groups. Conclusions: Our results showed significant disparities in ED mortality and patient disposition following cardiac arrest, highlighting the need for equitable healthcare resources and policies.

Takayasu arteritis, a rare and complex vasculitis, presents unique diagnostic and management challenges, particularly when encountered in young adults. We present the case of a 26-year-old female with obesity, prediabetes, hepatic steatosis, an adnexal cyst, Helicobacter pylori gastritis, and asthma, who was transferred to our facility due to concerns about aortitis. Her presentation to the referring institution included dysphagia, heartburn that responded to over-the-counter antacids, and recurrent episodes of stabbing chest pain, which had been occurring intermittently since the age of 17. Previous visits to the emergency room for these symptoms had been approached as gastritis, the last being two weeks before this episode. On evaluation, laboratory findings revealed elevated inflammatory markers, and subsequent imaging studies identified extensive circumferential wall thickening of the ascending thoracic aorta, suggestive of aortitis, and the patient was transferred to our institution. The patient’s complex medical history and psychosocial stressors, including estrangement from her family, added to the intricacies of her case. Rheumatology consultation was instrumental in guiding further evaluation and management. A diagnosis of Takayasu arteritis with large vessel vasculitis was considered, supported by positron emission tomography-computed tomography findings showing significant metabolic activity in major arteries. The patient was initiated on prednisone therapy, Pneumocystis jirovecii pneumonia prophylaxis, and methotrexate. Ongoing monitoring for disease activity and medication side effects was emphasized. This case highlights the importance of considering rare conditions such as Takayasu arteritis in young adults with atypical presentations and underscores the need for comprehensive, multidisciplinary care that addresses not only the medical aspects but also the psychosocial well-being of the patient.