Chest
Clinical Investigations in Critical CareEarly Predictors of Mortality for Hospitalized Patients Suffering Cardiopulmonary Arrest
Section snippets
PATIENTS AND METHODS
The Health Sciences Centre in Winnipeg is a 1,100 bed tertiary care hospital with a centralized CPR team based in MICU. All CPR is carried out by ACLS certified Residents or Intensive Care Fellows. Other team members include one Unit Assistant who performs CCCM, a MICU nurse who administers medications, a respiratory technologist and a second nurse who is designated to complete a comprehensive CPR data sheet during the event.6 All of the data sheets are returned to the MICU. The team responds
RESULTS
Of the 387 CPR records reviewed, 326 patients were identified as having experienced one or more true cardiopulmonary arrests. In the same period, there were 1,397 adult deaths in the hospital excluding the ED and OR. The ACLS was, therefore, provided for 326 patients minus the 30 survivors resulting in a selection ratio of 296/1,397 (21.2 percent). Complete information was obtained for 310 patients, and of the 16 remaining who could not be identified, initial outcome was unsuccessful in 13
DISCUSSION
Our study identified several intra-arrest factors associated with extremely low eventual survival in patients whose initial cardiopulmonary arrest occurred during hospitalization. Patients in whom the cardiopulmonary arrest was unwitnessed, those with the initial rhythms of asystole or EMD, and those in whom VF or VT proved to be refractory to more than three defibrillations or cardioversions almost uniformly died in hospital. We found that the administration of either intravenous epinephrine
ACKNOWLEDGMENTS
We would like to thank Dr. T. H. Hassard and T. A. J. McEwen for their assistance with statistical analysis and data processing and M. Rhymer for manuscript preparation and review.
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