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Failure to Predict Survival in Two Community Hospitals

Mark Rosenberg, MD; Constance Wang, MD; Susan Hoffman-Wilde, PhD; Dave Hickham, MD, MPH

Arch Intern Med. 1993;153(11):1370-1375.

Abstract
Background
The use of closed chest cardiopulmonary resuscitation (CPR) has, since its initial description in 1960, expanded greatly. Recently, much energy has focused on identifying patients' probabilities of responding to CPR. The goal of this study was to determine the current rate of successful CPR in two community teaching hospitals and to identify patient characteristics associated with the likelihood of successful resuscitation.

Methods
A retrospective review of the medical records of all patients receiving CPR during 1988 and 1989 in two university-affiliated teaching hospitals. This review identified 300 patients who experienced in-hospital cardiopulmonary arrest during the study period.

Results
Survival of CPR and survival to hospital discharge were 53.9% and 23.3% in the combined populations. Likelihood of survival of CPR was increased when the initial rhythm was ventricular tachycardia or ventricular fibrillation and when the duration of CPR was less than 30 minutes. Survival to hospital discharge was associated with shorter duration of CPR. Combinations of variables did not allow improved prediction of resuscitation results but did aid in predicting survival to hospital discharge. Combinations of variables that were associated with survival in one hospital were not transferable to the other institution.

Conclusion
Other than the length of resuscitation, easily accessible clinical variables provided limited predictive information about CPR results.

(Arch Intern Med. 1993;153:1370-1375)

Author Affiliations
From the Providence Medical Center (Dr Rosenberg), Oregon Health Sciences University (Drs Rosenberg and Hickham); Research and Development Veterans Affairs Medical Center (Dr Hickham), Portland; and Providence Medical Center, Seattle, Wash (Dr Wang). Dr Hoffman-Wilde is in private practice in Portland, Ore.

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