Elsevier

Resuscitation

Volume 68, Issue 2, February 2006, Pages 231-237
Resuscitation

CLINICAL PAPER
A decade of in-hospital resuscitation: Outcomes and prediction of survival?

https://doi.org/10.1016/j.resuscitation.2005.06.012Get rights and content

Summary

Objective

To provide survival rates and associated factors from a 10-year study of in-hospital cardiopulmonary resuscitation (CPR).

Design

Longitudinal prospective case register study of all adult in-hospital CPR attempts conducted from April 1993 to March 2003.

Setting

1200-bed general hospital in Plymouth (UK).

Patients

2121 adult in-hospital CPR attempts in Derriford Hospital, Plymouth during the period April 1993–March 2003.

Main outcome measures

Immediate, 24 h, hospital discharge and 12 month survival rates.

Results

Following CPR the immediate survival rate (95% confidence interval (C.I.)) was 38.6% (36.5, 40.7), then 24.7% (22.8, 26.6) at 24 h, 15.9% (14.4, 17.6) at discharge and 11.3% (10.0, 12.7) at 12 months. The primary arrhythmia, age, duration of arrest and time of arrest were strongly related to survival at 24 h and discharge. There were very low survival rates for pulse-less electrical activity (PEA) and asystole compared to VT/VF arrests; survival rates were highest for those less than 60 years and decreased with increasing age. The longer the resuscitation the less the survival, and those who arrested at night were less likely to survive. The primary arrest, respiratory or cardiac, was also independently associated with survival at 24 h but not with hospital discharge. Sex and the commencement of basic life support (BLS) within 3 min was not an independent predictor of survival.

Conclusion

The findings of this study show resuscitation survival rates from a 10-year study and indicate some of the key predictors of survival.

Introduction

Many studies have been performed to determine the effectiveness of CPR. However, there is still disagreement regarding absolute survival rates and reported success rates for CPR vary considerably.1, 2, 3, 4, 5, 6, 7, 8 Average survival to discharge has been about 15%, with some claims of improved survival over the last decade.2, 9, 10, 11, 12, 13, 14, 15, 16 However, these studies were highly selective compared to previous studies, tending to involve patients who were continuously monitored and admitted for acute coronary syndromes. In fact, one recent study from Edmonton hospitals in Canada17 showed in-hospital survival following CPR has not changed markedly in 40 years, but it is unclear whether these results can be extrapolated to the UK in-hospital population. An aging population and presumably a sicker inpatient population may mean that older survival data is incomparable, despite therapeutic improvements. Debate also continues regarding predictors of survival, for example, pre-arrest morbidity, age, sex and duration of resuscitation1, 17, 18, 19, 20, 21 an issue that needs to be clarified to assist, for example, with CPR termination decisions.1 The aim of this study, therefore, is to provide up-to-date in-hospital survival data and to assess the predictors of survival.

Section snippets

Patients and methods

The recruitment methods and patient population of this study have been described before.1, 18 In summary, a longitudinal prospective case register study conducted from April 1993 to March 2003, at Derriford Hospital, Plymouth (UK) a 1200-bed district general hospital.

There were 3616 resuscitation calls over the 10-year period. As recommended in the Utstein reporting style4 excluded from the study were 102 (2.8%) patients less than 20 years of age and 854 (23.6%) calls where the team was not

Results

The characteristics of patients who received CPR are shown in Table 1. Of the 2121 CPR calls, (1252 (59.0%) men and 869 (41.0%) women) there were 819 (38.6%; 95% C.I., 36.5, 40.7)) alive immediately, 524 (24.7%; 95% C.I., 22.8, 26.6)) alive at 24 h and 338 (15.9%; 95% C.I., 14.4, 17.6)) alive at discharge from hospital and 240 (11.3%; 95% C.I., 10.0, 12.7)) alive 12 months after CPR. PEA was the most frequent single arrest rhythm (42.0%) and asystole was the second most frequent (20.8%). Time of

Discussion

In this 10-year case study of 2121 in-hospital CPR calls the 24 h survival rate was 25 and 15.9% at discharge from hospital. Survival rates decrease with increasing age and arrest duration and were particularly low following PEA and asystole arrests. International survival rates do vary,1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 probably because of differing study designs, sample sizes and assessment methods. For example, in some studies28 multiple re-arrests are

Conflict of interest statement

There is no conflict of interest with this work.

Acknowledgement

Many thanks to Dr. Hilary Sanders, Department of Mathematics and Statistics, University of Plymouth, UK, for her advice on the statistical methods used in this study.

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    A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2005.06.012.

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