Outcome of cardiopulmonary resuscitation in intensive care units in a university hospital

Abstract

The purpose of this study is to evaluate the demographic characteristics of patients who suffered cardiac arrest in our intensive care units (ICUs) as well as to identify those factors influencing outcome after resuscitation following cardiac arrest.

Methods: We reviewed the records of all patients who underwent cardiopulmonary resuscitation (CPR) in our ICUs at the Georg-August University Hospital, Goettingen, Germany, from January 1, 1999 to December 31, 2003.

Results: One hundred and sixty-nine patients underwent CPR. Severity of illness assessed by SAPS II score on admission was 51.8+/-18.5 (predicted mortality 46.6%). The initially monitored rhythm at the time of arrest was asystole in 51 (30.2%) patients. Ventricular tachycardia/fibrillation (VT/VF) was recorded in 65 (38.5%) and pulseless electrical activity in 49 (29.0%) patients. Twenty (23.8%), 28 (33.3%) and 33 (39.3%) patients with initially recorded asystole, VT/VF and pulseless electrical activity (PEA) rhythms, respectively, survived to ICU discharge. Eighty of the 169 patients survived to hospital discharge giving a survival rate of 47.3%. The highest ICU mortality was seen in patients admitted for neurosurgery (80%) followed by major vascular surgery (77.8%), non-surgical patients (67.4%) and patients with severe sepsis (66.7%). The occurrence of cardiac arrest within the first 24h was associated with a significantly lower ICU mortality compared to a later incident. At hospital discharge 66 patients (82.5% of the survivors) achieved good cerebral recovery, 12 patients (15.0%) were severely disabled (CPC 3) while 2 (2.5%) remained unconscious.

Conclusion: Several factors affect the outcome from CPR. However, quicker triage to ICU, closer monitoring along with prompt intervention might minimise the consequences of cardiac arrest and its complications.