PURPOSE: To determine if pre-existing and current co-morbidities predict outcomes from cardiopulmonary arrest (CPA).
METHODS: A retrospective review of all 729 patients undergoing resuscitation efforts for CPA in a large university medical center between July 2000 and October 2005. Pre-hospital co-morbidity was calculated according to the Charlson Index (CSS). Major system co-morbidities were extracted from the discharge ICD-9 codes. End points were return of spontaneous circulation (ROSC) and death at discharge.
RESULTS: Overall hospital mortality was 79%. Of the 53% with ROSC, mortality was 60%. The preadmission CSS was not a predictor of either ROSC or in-hospital mortality. Discharge ICD-9 code analysis revealed that predictors of lower in-hospital mortality were: neurologic diagnosis (68% with vs. 81% without; p=0.003), trauma (69 vs. 80%; p=0.021), and electrolyte abnormality (69 vs. 82%; p=0.0009). Predictors of greater mortality were: Renal disease (85 vs 77%; p=0.019), HIV/Immune disease (89 vs. 78%; p=0.018), and obesity (88 vs. 77%; p=0.018). The following disease categories did not predict mortality: alcoholism, cardiovascular, pulmonary, endocrine, GI, diabetes, hypertension, cancer, infectious, tobacco use, number of organ systems involved. Time of day for the CPA did not predict either ROSC or overall in-hospital mortality.
CONCLUSION: In-hospital mortality from CPA is very high, and is not predicted by pre-hospital morbidity scores. There are some major disease categories that do carry some predictive weight, although mortalities were still high.
CLINICAL IMPLICATIONS: Mortality from in-hospital CPA is high and largely not related to co-morbidities.
DISCLOSURE: Dafna Koldobskiy, None.