Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff

Chest. 1995 Oct;108(4):1009-17. doi: 10.1378/chest.108.4.1009.

Abstract

Objective: To identify a series of variables which predict death after in-hospital cardiopulmonary resuscitation (CPR).

Design: Retrospective observational study.

Setting: A nonteaching community hospital with 24-hr on-site critical care specialists.

Patients: Consecutive adults undergoing CPR between August 1989 and July 1991.

Intervention: None.

Measurements and main results: Two hundred forty-two patients suffered a total of 289 cardiopulmonary arrests. Forty patients (16.5%) survived to discharge. Thirty-nine (16%) patients had more than one cardiopulmonary arrest. Survival of second CPR was 18%. Acute physiology and chronic health evaluation (APACHE) II scores within 24 h of admission and CPR (APACHE[a] and APACHE[b]) were measured. APACHE(a) and (b) scores more than 20 had a 96% predictive value positive and were associated with a five-fold decrease in survival. Besides APACHE, cardiopulmonary arrests on medical floors and after day 4 of hospitalization, duration of CPR more than 15 min, and asystole assumed significance at multivariate levels for predicting death. Ventilatory assistance and Glasgow coma score of less than 9 at 24 h after CPR predicted death for initial survivors at multivariate levels. Survival on telemetry units were similar to the ICU (17 vs 21%) but twice that of the medical floors.

Conclusions: The CPR outcome can be predicted early during hospital course, which may assist physicians to formulate a do-not-resuscitate order. Patients surviving a CPR should be considered candidates for another resuscitation if clinically warranted. Low-risk patients can safely be admitted to telemetry units instead of to more costly ICUs.

Publication types

  • Comparative Study

MeSH terms

  • APACHE
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / mortality*
  • Cardiopulmonary Resuscitation / statistics & numerical data
  • Chi-Square Distribution
  • Critical Care*
  • Female
  • Hospital Mortality*
  • Hospitals, Community* / statistics & numerical data
  • Humans
  • Illinois / epidemiology
  • Male
  • Middle Aged
  • Missouri / epidemiology
  • Patient Discharge / statistics & numerical data
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome