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Outcome of Adult Cardiopulmonary Resuscitations at a Tertiary Referral Center Including Results of "Limited" Resuscitations
John A. Dumot, DO;
Daniel J. Burval, BS;
Juraj Sprung, MD, PhD;
Jonathan H. Waters, MD;
Boris Mraovic, MD;
Matthew T. Karafa, MS;
Edward J. Mascha, MS;
Denis L. Bourke, MD
Arch Intern Med. 2001;161:1751-1758.
Background The results of in-hospital resuscitations may depend on a variety of
factors related to the patient, the environment, and the extent of resuscitation
efforts. We studied these factors in a large tertiary referral hospital with
a dedicated certified resuscitation team responding to all cardiac arrests.
Methods Statistical analysis of 445 prospectively recorded resuscitation records
of patients who experienced cardiac arrest and received advanced cardiac life
support resuscitation. We also report the outcomes of an additional 37 patients
who received limited resuscitation efforts because of advance directives prohibiting
tracheal intubation, chest compressions, or both.
Main Outcome Measures Survival immediately after resuscitation, at 24 hours, at 48 hours,
and until hospital discharge.
Results Overall, 104 (23%) of 445 patients who received full advanced cardiac
life support survived to hospital discharge. Survival was highest for patients
with primary cardiac disease (30%), followed by those with infectious diseases
(15%), with only 8% of patients with end-stage diseases surviving to hospital
discharge. Neither sex nor age affected survival. Longer resuscitations, increased
epinephrine and atropine administration, multiple defibrillations, and multiple
arrhythmias were all associated with poor survival. Patients who experienced
arrests on a nursing unit or intensive care unit had better survival rates
than those in other hospital locations. Survival for witnessed arrests (25%)
was significantly better than for nonwitnessed arrests (7%) (P = .005). There was a disproportionately high incidence of nonwitnessed
arrests during the night (12 AM to 6 AM) in unmonitored beds, resulting in
uniformly poor survival to hospital discharge (0%). None of the patients whose
advance directives limited resuscitation survived.
Conclusions Very ill patients in unmonitored beds are at increased risk for a nonwitnessed
cardiac arrest and poor resuscitation outcome during the night. Closer vigilance
of these patients at night is warranted. The outcome of limited resuscitation
efforts is very poor.
From the Departments of Gastroenterology (Dr Dumot), General Anesthesiology
(Drs Sprung and Waters), and Biostatistics and Epidemiology (Messrs Karafa
and Mascha), the Cleveland Clinic Foundation, Cleveland, Ohio; West Virginia
University School of Medicine, Morgantown (Mr Burval); the Department of Anesthesiology,
Rush-Presbyterian Medical Center, Chicago, Ill (Dr Mraovic); and the Department
of Anesthesiology, Baltimore Veterans Affairs Medical Center, University of
Maryland, Baltimore (Dr Bourke).
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