Original Article

Survival After In-Hospital Cardiopulmonary Resuscitation

Authors: Robert P. Ferguson, MD, Timothy Phelan, MD, Tarik Haddad, MD, Anish Hinduja, MD, Norman H. Dubin, PhD

Abstract


Background: The use of postarrest variables to predict survival after discharge following in-hospital cardiopulmonary resuscitation has not been definitive. This study evaluates whether the duration of cardiopulmonary resuscitation (CPR) and other variables affect discharge rates and survival rates after discharge.


Methods: Prospective cohort survival data and arrest variables were collected, including initial observed rhythm, duration of CPR, time of arrest, and number of arrests. Arrests on unmonitored general medical units, monitored telemetry units, and critical care units were included. Outcome measures were: survival after CPR, 24 hours post-CPR, survival to discharge, and to six months postdischarge.


Results: At both discharge and six months after discharge, ventricular fibrillation and ventricular tachycardia were associated with better survival rates than other initial rhythms (P < 0.001). There were significantly higher survival rates (P < 0.001) for those receiving CPR for ≤10 minutes as compared with those receiving CPR >10 minutes. Multiple versus single arrests and monitored versus unmonitored arrests approached significance. The time of day of the arrest was not a significant factor.


Conclusions: Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge and six months postdischarge. Low six-month survival rates may reflect the relatively high proportion of initial rhythms other than ventricular in the study group.



This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA 1960;173:1064–1067.
 
2. Saphir R. External cardiac massage. Prospective analysis of 123 cases and review of the literature. Medicine (Baltimore) 1968;47:73–87.
 
3. Ebell MH, Becker LA, Barry HC, et al. Survival after in-hospital cardiopulmonary resuscitation. A meta-analysis. J Gen Intern Med 1998;13:805–816.
 
4. Robinson GR II, Hess D. Postdischarge survival and functional status following in-hospital cardiopulmonary resuscitation. Chest 1994;105:991–996.
 
5. Brindley PG, Markland DM, Mayers I, et al. Predictors of survival following in-hospital adult cardiopulmonary resuscitation. CMAJ 2002;167:343–348.
 
6. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297–308.
 
7. Tunstall-Pedoe H, Bailey L, Chamberlain DA, et al. Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. BMJ 1992;304:1347–1351.
 
8. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006;295:50–57.
 
9. Matot I, Shleifer A, Hersch M, et al. In-hospital cardiac arrest: is outcome related to the time of arrest? Resuscitation 2006;71:56–64.
 
10. Zoch TW, Desbiens NA, DeStefano F, et al. Short- and long-term survival after cardiopulmonary resuscitation. Arch Intern Med 2000;160:1969–1973.
 
11. Cummins RO, Chamberlain D, Hazinski MF, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style.’ American Heart Association. Circulation 1997;95:2213–2239.
 
12. Cooper S, Janghorbani M, Cooper G. A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation 2006;68:231–237.
 
13. Cooper S, Cade J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation 1997;35:17–22.
 
14. Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 2000;44:7–17.
 
15. Rajaram R, Rajagopalan RE, Pai M, et al. Survival after cardiopulmonary resuscitation in an urban Indian hospital. Natl Med J India 1999;12:51–55.
 
16. Spearpoint KG, McLean CP, Zideman DA. Early defibrillation and the chain of survival in ‘in-hospital’ adult cardiac arrest; minutes count. Resuscitation 2000;44:165–169.
 
17. Kaye W, Mancini ME, Truitt TL. When minutes count—the fallacy of accurate time documentation during in-hospital resuscitation. Resuscitation 2005;65:285–290.
 
18. Bialecki L, Woodward RS. Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff. Chest 1995;108:1009–1017.