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

doi:10.1001/archinte.1994.00420210060007

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Vol. 154 No. 21, 14 November 1994

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Predictors of Survival Following In-Hospital Cardiopulmonary Resuscitation

A Moving Target

Kenneth A. Ballew, MD, MS; John T. Philbrick, MD; Dean E. Caven; John B. Schorling, MD, MPH

Arch Intern Med. 1994;154(21):2426-2432.

Abstract

Background
Counseling patients about the risks and benefits of in-hospitalcardiopulmonary resuscitation (CPR) can potentially reduce patientsuffering and hospital costs. However, there is currently muchdisagreement regarding the overall rate of in-hospital CPR survivaland characteristics that identify patients more or less likelyto survive CPR.

Methods
The charts of all adults who were pulseless and received basicCPR at a 720-bed university hospital during 1990 and 1991 werereviewed. Patients were excluded if cardiac arrest occurredoutside the hospital or in the emergency department, operatingroom, recovery room, or cardiac catheterization laboratory.Each patient's chart was reviewed to determine the presenceof explicitly defined clinical characteristics.

Results
Overall, 50 (16.0%) of 313 patients survived to discharge. Beforearrest, only impaired functional capacity and sepsis identifiedpatients unlikely to survive CPR. Of adults suffering cardiacarrest during the study period, only 22% underwent CPR, including13.0% of those with cancer and 18.1% of those 70 years or older.

Conclusions
The use of do-not-resuscitate orders to exclude patients whowere inappropriate candidates for CPR may explain why the survivalrate reported here is higher than similar reports and why moreclinical characteristics were not found to predict CPR survival.Investigators of inhospital CPR should use explicit criteriato describe the conditions studied and report survival for patientswho receive basic CPR. The impact of do-not-resuscitate orderson survival rates must be considered. Functional capacity deservesfurther investigation as a predictor of CPR survival.

(Arch Intern Med. 1994;154:2426-2432)

Author Affiliations

From the Division of General Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville.

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