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Predictors of Survival Following In-Hospital Cardiopulmonary Resuscitation: A Moving Target

Predictors of Survival Following In-Hospital Cardiopulmonary Resuscitation: A Moving Target Abstract Background: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. Methods: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. Results: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. Conclusions: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of inhospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.(Arch Intern Med. 1994;154:2426-2432) References 1. Blackhall LJ, Ziogas A, Azen SP. Low survival rate after cardiopulmonary resuscitation in a county hospital . Arch Intern Med. 1992;152:2045-2048.Crossref 2. Lawrence ME, Price L, Riggs M. Inpatient cardiopulmonary resuscitation: is survival prediction possible? South Med J. 1991;84:1462-1466.Crossref 3. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style . Ann Emerg Med. 1991;20:861-874.Crossref 4. Ballew KA, Schorling JB, Caven DE, Philbrick JT. Differences in case definitions as a cause of variation in reported in-hospital cardiopulmonary resuscitation survival . J Gen Intern Med. 1994;9:283-285.Crossref 5. Quill TE, Bennett NM. The effects of a hospital policy and state legislation on resuscitation orders for geriatric patients . Arch Intern Med. 1992;152:569-572.Crossref 6. Stern SG, Orlowski JP. DNR or CPR—the choice is ours . Crit Care Med. 1992; 20:1263-1272.Crossref 7. Jayes RL, Zimmerman JE, Knaus WA, Wagner DP, Draper EA. Changes in do not resuscitate order writing in intensive care units: findings from a national study . Clin Res. 1993;41:540A. Abstract. 8. American Heart Association. Textbook of Advanced Cardiac Life Support . 2nd ed. Dallas, Tex: American Heart Association; 1990. 9. Dawber TR. The Framingham Study: the Epidemiology of Atherosclerotic Disease . Cambridge, Mass: Harvard University Press; 1980:5-33. 10. Bone RC. Let's agree on terminology: definitions of sepsis . Crit Care Med. 1991; 19:973-976.Crossref 11. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital . N Engl J Med. 1983;309:569-576.Crossref 12. SAS Institute Inc. SAS/STAT User's Guide. Release 6.03 ed. Cary, NC: SAS Institute Inc; 1988:1028. 13. Urberg M, Ways C. Survival after cardiopulmonary resuscitation for an in-hospital cardiac arrest . J Fam Pract. 1987;25:41-44. 14. Woog RH, Torzillo PJ. In-hospital cardiopulmonary resuscitation: prospective survey of management and outcome . Anaesth Intensive Care. 1987;15:193-198. 15. Taffett GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation . JAMA. 1988;260:2069-2072.Crossref 16. O'Keefe S, Redahan C, Keane P, Daly K. Age and other determinants of survival after in-hospital cardiopulmonary resuscitation . Q J Med. 1991;81:1005-1010.Crossref 17. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly . Ann Intern Med. 1989;111:199-205.Crossref 18. Vitelli CE, Cooper K, Rogatko A, Brennan MF. Cardiopulmonary resuscitation and the patient with cancer . J Clin Oncol. 1991;9:111-115. 19. Hendrick JMA, Pijls NHJ, Van der Werf T, Crul JF. Cardiopulmonary resuscitation on the general ward: no category of patients should be excluded in advance . Resuscitation. 1990;20:163-171.Crossref 20. Rosenberg M, Wang C, Hoffman-Wilde S, Hickham D. Results of cardiopulmonary resuscitation: failure to predict survival in two community hospitals . Arch Intern Med. 1993;153:1370-1375.Crossref 21. Shelman RG, Fulkerson WJ, DeLong E, Piantadosi CA. Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit . Crit Care Med. 1988;16:671-678.Crossref 22. National Institute of Neurological and Communicative Disorders and Stroke. The national survey of stroke . Stroke. 1981;12( (suppl 1) ):I-32—I-35. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Predictors of Survival Following In-Hospital Cardiopulmonary Resuscitation: A Moving Target

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420210060007
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. Methods: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. Results: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. Conclusions: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of inhospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.(Arch Intern Med. 1994;154:2426-2432) References 1. Blackhall LJ, Ziogas A, Azen SP. Low survival rate after cardiopulmonary resuscitation in a county hospital . Arch Intern Med. 1992;152:2045-2048.Crossref 2. Lawrence ME, Price L, Riggs M. Inpatient cardiopulmonary resuscitation: is survival prediction possible? South Med J. 1991;84:1462-1466.Crossref 3. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style . Ann Emerg Med. 1991;20:861-874.Crossref 4. Ballew KA, Schorling JB, Caven DE, Philbrick JT. Differences in case definitions as a cause of variation in reported in-hospital cardiopulmonary resuscitation survival . J Gen Intern Med. 1994;9:283-285.Crossref 5. Quill TE, Bennett NM. The effects of a hospital policy and state legislation on resuscitation orders for geriatric patients . Arch Intern Med. 1992;152:569-572.Crossref 6. Stern SG, Orlowski JP. DNR or CPR—the choice is ours . Crit Care Med. 1992; 20:1263-1272.Crossref 7. Jayes RL, Zimmerman JE, Knaus WA, Wagner DP, Draper EA. Changes in do not resuscitate order writing in intensive care units: findings from a national study . Clin Res. 1993;41:540A. Abstract. 8. American Heart Association. Textbook of Advanced Cardiac Life Support . 2nd ed. Dallas, Tex: American Heart Association; 1990. 9. Dawber TR. The Framingham Study: the Epidemiology of Atherosclerotic Disease . Cambridge, Mass: Harvard University Press; 1980:5-33. 10. Bone RC. Let's agree on terminology: definitions of sepsis . Crit Care Med. 1991; 19:973-976.Crossref 11. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital . N Engl J Med. 1983;309:569-576.Crossref 12. SAS Institute Inc. SAS/STAT User's Guide. Release 6.03 ed. Cary, NC: SAS Institute Inc; 1988:1028. 13. Urberg M, Ways C. Survival after cardiopulmonary resuscitation for an in-hospital cardiac arrest . J Fam Pract. 1987;25:41-44. 14. Woog RH, Torzillo PJ. In-hospital cardiopulmonary resuscitation: prospective survey of management and outcome . Anaesth Intensive Care. 1987;15:193-198. 15. Taffett GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation . JAMA. 1988;260:2069-2072.Crossref 16. O'Keefe S, Redahan C, Keane P, Daly K. Age and other determinants of survival after in-hospital cardiopulmonary resuscitation . Q J Med. 1991;81:1005-1010.Crossref 17. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly . Ann Intern Med. 1989;111:199-205.Crossref 18. Vitelli CE, Cooper K, Rogatko A, Brennan MF. Cardiopulmonary resuscitation and the patient with cancer . J Clin Oncol. 1991;9:111-115. 19. Hendrick JMA, Pijls NHJ, Van der Werf T, Crul JF. Cardiopulmonary resuscitation on the general ward: no category of patients should be excluded in advance . Resuscitation. 1990;20:163-171.Crossref 20. Rosenberg M, Wang C, Hoffman-Wilde S, Hickham D. Results of cardiopulmonary resuscitation: failure to predict survival in two community hospitals . Arch Intern Med. 1993;153:1370-1375.Crossref 21. Shelman RG, Fulkerson WJ, DeLong E, Piantadosi CA. Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit . Crit Care Med. 1988;16:671-678.Crossref 22. National Institute of Neurological and Communicative Disorders and Stroke. The national survey of stroke . Stroke. 1981;12( (suppl 1) ):I-32—I-35.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 14, 1994

References