|Home | About | Journals | Submit | Contact Us | Français|
This study aims to provide survival data for adult patients following attempted cardiopulmonary resuscitation (CPR) in critical care units. We hope objective data can facilitate dialogue and decision-making.
We retrospectively reviewed CPR records from 1 January 1 2000 to 30 April 2005 from all critical care units of the tertiary care hospitals of Edmonton, Canada. Full inpatient medical records were reviewed for further details.
Of 529 arrests, 59.4% had return of spontaneous circulation, 29.5% survived to critical care unit discharge, 26.3% survived to hospital discharge, 20.5% survived to 3 months, and 19.9% to 6 months. Pulseless electrical activity (PEA) represented 29.7%, ventricular tachycardia (VT) 20.8%, asystole (ASY) 15.7%, bradycardia 15.5%, ventricular fibrillation (VF) 13.4%, supraventricular tachycardia 2.8%, and respiratory arrest 2.1%. A total 36.7% of arrests occurred between 08:01 and 16:00 hours, 33.0% occurred between 00:01 and 08:00 hours and 30.3% between 16:01 and 24:00 hours. There was no significant association between arrest time and survival. There was a significant association between longer CPR duration and increased mortality (P < 0.001). GSICU cardiac arrest patients had statistically higher critical care unit mortality than CCU or CVICU patients (75.5% vs 70.0% vs 45.7%; P = 0.002). ASY/PEA were significantly more common in GSICUs, whereas VF and VT were more common in CVICU (P = 0.001). Mortality was significantly higher following PEA/ASY regardless of location. Multivariate analysis showed no significant association between survival and age, gender or arrest time. In contrast, survival was significantly lower with increased APACHE II score (O.R 1.07, P < 0.001), prolonged CPR (O.R.1.03, P < 0.01), and ASY/PEA (O.R. 5.44, P < 0.001). No patient with an APACHE II ≥30 survived to hospital discharge following PEA.ASY, and no patient, regardless of arrest type, survived to hospital discharge with an APACHE II >45.
Initial survival following in-hospital cardiac arrest is higher than from noncritical care units, and therefore should be considered differently. Survival was higher still from cardiac ICUs compared with other critical care units. Admission APACHE II, type of arrest, and resuscitation duration provide useful prognosticators, especially in combination. In contrast, age, gender, and arrest time do not. Despite encouraging early survival, less than one-quarter survived to hospital discharge, and less than one-in-six were alive at 1 year.