PURPOSE: No previous study had looked at survival to hospital discharge after multiple cardiopulmonary arrests. We hypothesized that patients with multiple cardiopulmonary arrests are less likely to survive to hospital discharge. We aimed to evaluate their survival and assess for clinical predictors associated with mortality.
METHODS: A retrospective chart review of 75 adults, aged 18years or older who experienced cardiopulmonary arrest and received resuscitation between January 2008 and November 2010 was conducted in a community teaching hospital. The patients were divided into two groups: group with one cardiopulmonary arrest (n=46), and group with two or more cardiopulmonary arrests (n=29). The two groups were evaluated for survival rates as the primary outcome, and for clinical predictors of mortality.
RESULTS: Of 75 patients included, the group with one cardiopulmonary arrest had a higher survival rate compared to the group with two or more cardiopulmonary arrests (39.1% vs 24.1% p=0.2152). Patients who had two or more cardiopulmonary arrests were older (mean age 71+15.5 vs 63.5+15.31 p=0.0433) and had substantially more prevalence of heart failure (HF), chronic renal failure (CRF) and coronary artery disease (CAD) (HF: 66% vs 39% p=0.0339; CRF 62% vs29% p=0.0034; CAD 55% vs 30% p=0.0522 respectively). To correct for this heterogeneity, we conducted a sub-analysis of patients older than 60years who had similar co-morbidities (n=48). This showed that the survival rate of patients who received two or more CPRs (n=21) compared to patients with one CPR (n=27) was 14% and 37% (p=0.1) and CRF was more prevalent in the former (62% vs 26% p=0.01).
CONCLUSIONS: These results confirm our hypothesis that patients with multiple cardiopulmonary arrests are less likely to survive to hospital discharge. Older age, CAD, HF and CRF were associated with and may contribute to worse outcomes.
CLINICAL IMPLICATIONS: Awareness of mortality outcomes of patients who experience multiple cardiopulmonary arrests may inform advance care planning. We hope our findings would encourage more meaningful dialogue among physicians, patients and their families regarding resuscitation wishes.
DISCLOSURE: The following authors have nothing to disclose: Khaldoon Shaheen, Khalid Alokla, Motaz Baibars, Ifiok Idem, Olatunji Olaoye, Emmanuel Elueze, Daniel Iltchev, Joseph Sopko, M. Chadi Alraies
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