PURPOSE: Unfortunately, the survival rate in patients undergoing in-hospital cardiopulmonary resuscitation (CPR) remains low. Our study was intended to evaluate the outcome of repeating CPR, on the same patient during the same hospitalization.
METHODS: We conducted retrospective chart review of patients undergoing repeated CPR as a consequence of true cardiopulmonary arrest after the first initial successful attempt, in our hospital, between June 1, 2000, and October 1, 2006. Cardiac and pulmonary arrests were defined in accordance with the Utstein-Style guidelines, where successful resuscitation was defined as the return of spontaneous circulation (ROSC) or detected cardiac output for more than 24 hours. Data collected included the patients’ demographics, admission diagnosis, prior history of cardiac or pulmonary arrest, type and time of arrest, and time to performing CPR. Our primary endpoint was survival to discharge.
RESULTS: 151 patients 87 (57.6%) males, 64 (42.4%) females, ages 25 to 99 years (average 66.8), sustained at least one in-hospital cardiopulmonary arrest and underwent CPR. Out of those patients, only 16, 8 (50%) males and 8 (50%) females, ages 34 to 99 years (average 62) required repeated CPR after the first successful attempt. None of these patients survived to the time of discharge from the hospital (0% survival rate [p-value 0.004 with 95% CI 0.06 to 0.17]).
CONCLUSION: The outcome of in-hospital cardiopulmonary arrest remains disappointing; however, the prognosis of those who survive the first event and require repeated attempts of resuscitation appears to be grim. The prognosis, in our study, was independent of sex, age, admitting diagnosis, time and type of the event, and time to initiating CPR.
CLINICAL IMPLICATIONS: Seriously ill patients and their families should be well informed regarding the expected outcome of multiple in-hospital resuscitation events. Appropriate changes in their code status may avoid unnecessary effort and emotional distress resulting from multiple arrests and CPR attempts.
DISCLOSURE: Giath Shari, No Financial Disclosure Information; No Product/Research Disclosure Information