Chest
Volume 97, Issue 2, February 1990, Pages 413-419
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Clinical Investigations in Critical Care
Early Predictors of Mortality for Hospitalized Patients Suffering Cardiopulmonary Arrest

https://doi.org/10.1378/chest.97.2.413Get rights and content

Few if any prearrest or intraarrest variables have been identified as highly predictive of inhospital mortality following cardiopulmonary arrest. A total of 310 consecutive patients requiring advanced cardiac life support during the calendar years 1985 and 1986 were reviewed with respect to eight specific variables. These included age, diagnosis, location, mechanism of the event, duration of resuscitation, whether the event was witnessed or unwitnessed, the initial observed rhythm and medications administered. A total of 37.1 percent of the patients were successfully resuscitated, but only 9.7 percent survived until discharge. Factors strongly associated with inhospital mortality included unwitnessed events (p = 0.0316), the need for epinephrine (p = 0.0003), identification of electromechanical dissociation or asystole as initial rhythms (p = 0.0000), and cardiac vs respiratory mechanism of arrest (p = 0.0000).

(Chest 1990; 97:413–19)

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.

REFERENCES (12)

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revision accepted July 14.

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