Predictors of survival following in-hospital adult cardiopulmonary resuscitation

Abstract

Background: This study was undertaken to provide up-to-date survival data for Canadian adult in-patients following attempted resuscitation from cardiac or respiratory arrest. We hope that objective data might encourage more meaningful dialogue between physicians, patients and their families regarding resuscitation wishes.

Methods: We reviewed all records of adult cardiopulmonary arrest that occurred between Jan. 1, 1997, and Jan. 31, 1999, at the 3 main teaching hospitals in Edmonton. We then abstracted data from the full inpatient medical records to describe patient characteristics, type of arrest and survival details. The family physicians of survivors were contacted to confirm the outcomes. We included only adults admitted to hospital but not to a critical care bed.

Results: There were 247 arrests during the study period; 143 (57.9%) were witnessed, and 104 (42.1%) were unwitnessed). Of the patients whose arrests were witnessed, 48.3% (95% confidence interval [CI] 39.8%-56.8%) were able to be resuscitated, 22.4% (95% CI 1 5.8%-30.1%) survived to hospital discharge, and 18.9% (95% CI 12.8%-26.3%) were able to return home. Survival was highest after primary respiratory arrest and lowest after pulseless electrical activity or asystole. Of the patients with unwitnessed arrests, 21.2% (95% CI 13.8%-30.3%) were able to be resuscitated, but only 1 patient (1.0% [95% CI 0.0%-5.2%]) survived to hospital discharge and was able to return home. This patient survived an unwitnessed respiratory arrest. No patient who had an unwitnessed cardiac arrest survived to discharge. Most of the respiratory arrests were witnessed (93.1%), and most of the pulseless electrical activity or asystole arrests were unwitnessed (54.6%). We did not find age or sex to be independent predictors of survival. However, the risk of not returning home was higher among patients whose arrest occurred between 2301 and 0700 than among those whose arrest was between 0701 and 1500 (adjusted OR 3.2, 95% CI 1.0-10.1). Survival was significantly decreased after pulseless ventricular tachycardia or ventricular fibrillation arrest (adjusted OR 4.2, 95% CI 1.4-12.5) and even more so after pulseless electrical activity or asystole arrest (adjusted OR 21.0, 95% CI 6.2-71.7) than after respiratory arrest.

Interpretation: Overall, survival following cardiopulmonary resuscitation in hospital does not appear to have changed markedly in 40 years. The type of arrest is highly predictive of survival, whereas age and sex are not.