Early Predictors of Mortality for Hospitalized Patients Suffering Cardiopulmonary Arrest

Roberts, Daniel; Landolfo, Kevin P.; Light, R. Bruce; Dobson, Karen

doi:10.1378/chest.97.2.413

Cited by 114 publications

(47 citation statements)

References 11 publications

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“…Survival was higher among our patients than among patients in previous studies whose arrest occurred in non-ICU hospital settings. 4,[14][15][16][17][18][19][20] About 60% of the patients in our study were initially resuscitated, and just over one-quarter survived to hospital discharge. In comparison, our previous study of survival outcomes following arrest in non-ICU hospital wards showed that about one-third regained a pulse, and 13% survived to hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Predictors of survival after cardiac or respiratory arrest in critical care units

Kutsogiannis¹,

Bagshaw²,

Laing³

et al. 2011

CMAJ

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C ardiac arrest remains a major clinical and public health problem.1 Studies of cardiac arrest in volving patients admitted to non-critical care beds showed that survival has not improved despite 40 years of medical advances.2−4 Outside of critical care units, survival was substantially lower for nonwitnessed arrests than for witnessed arrests; for cardiac than for respiratory arrests; for arrests due to asystole or pulseless electrical activity than for those due to ventricular fibrillation or ventricular tachycardia; and for arrests occurring early in the morning than for those at other times of the day.2-4 How these data apply to approximately one-third of in-hospital cardiac arrests that occur in intensive care units (ICUs) is less clear.Arrests in ICUs might be expected to have increased survival because universal cardiac monitoring and a high nurse-to-patient ratio would mean that the arrests would be witnessed regardless of the time of day. On the other hand, survival might be expected to be lower because critical care patients have a high disease burden and experience arrests despite aggressive preemptive life support. Also, patients in a general ICU might be expected to have poorer survival than those in a coronary care or cardiovascular surgical ICU because they typically have primary noncardiac diagnoses; therefore, cardiac arrest in these patients implies cardiovascular collapse in addition to noncardiac illness (i.e., at least two-organ failure). 3,4 We evaluated survival outcomes during a five-year follow-up period among adult patients who experienced cardiac or respiratory arrest in ICUs at four hospitals. We also identified risk factors associated with decreased survival after 24 hours.

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Section: Discussionmentioning

confidence: 99%

Predictors of survival after cardiac or respiratory arrest in critical care units

Kutsogiannis¹,

Bagshaw²,

Laing³

et al. 2011

CMAJ

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“…Four cohort studies reported that bicarbonate use was associated with poor short-and long-term outcome (LOE 2). 217,[241][242][243] Treatment Recommendation Routine administration of sodium bicarbonate for treatment of in-hospital and out-of-hospital cardiac arrest is not recommended.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…For example, several studies have shown that pneumonia is a strong predictor of poor outcome, 12,37 others have not. 32,55 Two previous meta-analyses examined the relation between pre-arrest variables and survival after in-hospital CPR. 58,59 On the one hand, meta-analyses have the advantage of greater power to detect variables associated with the outcome of CPR, and may offer greater generalizability because patients studied are drawn from several institutions.…”

Section: Jgimmentioning

confidence: 99%

“…A total of 41 studies met the minimal inclusion criteria, while only 10 studies met the strict inclusion criteria. 19,24,26,27,32,43,45,47,53,55 …”

Section: Data Abstractionmentioning

confidence: 99%

Survival after in-hospital cardiopulmonary resuscitation

et al. 1998

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OBJECTIVE:To determine the rates of immediate survival and survival to discharge for adult patients undergoing in-hospital cardiopulmonary resuscitation, and to identify demographic and clinical variables associated with these outcomes. MEASUREMENTS AND MAIN RESULTS:The MEDLARS database of the National Library of Medicine was searched. In addition, the authors' extensive personal files and the bibliography of each identified study were searched for further studies. Two sets of inclusion criteria were used, minimal (any study of adults undergoing in-hospital cardiopulmonary resuscitation) and strict (included only patients from general ward and intensive care units, and adequately defined cardiopulmonary arrest and resuscitation). Each study was independently reviewed and abstracted in a nonblinded fashion by two reviewers. The data abstracted were compared, and any discrepancies were resolved by consensus discussion. For the subset of studies meeting the strict criteria, the overall rate of immediate survival was 40.7% and the rate of survival to discharge was 13.4%. The following variables were associated with failure to survive to discharge: sepsis on the day prior to resuscitation (odds ratio T he do-not-resuscitate (DNR) order has become well accepted and widely used in American hospitals, and for the majority of patients who die in the hospital, a DNR order has been written by the time of their death. 1-3 The decision to discuss or execute a DNR order is driven by several concerns: the patient's current quality of life, the likelihood that cardiopulmonary resuscitation (CPR) will be successful, the patient's long-term prognosis following successful resuscitation, and his or her anticipated quality of life following successful resuscitation. 4,5 Although judgments about quality of life are best assessed by the patient, physicians have typically been relied on to provide biomedical information and estimates of prognosis; this is consistent with a shared approach to medical decision making. Information about prognosis can either be communicated implicitly (e.g., "I don't think CPR is likely to help you") or explicitly ("Patients with your condition have a less than 1% chance of surviving to discharge after CPR"). The explicit approach has been shown in two studies to influence patient decisions about DNR orders, 6,7 so it is important that prognostic information be as accurate as possible.[Recent work has shown, however, that physicians are not accurate in predicting the outcome of CPR. In fact, when presented with detailed vignettes of actual patient cases, physician predictions of the likelihood of immediate survival following CPR were no better than random guessing, with an area under the receiver-operating characteristic (ROC) curve not significantly different from 0.5. 8 An analysis with the physician prediction of the likelihood of survival as the outcome variable in a multivariate regression shows that physicians appear to have an underlying cognitive model. However, this model overemphasizes the imp...

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Early Predictors of Mortality for Hospitalized Patients Suffering Cardiopulmonary Arrest

Cited by 114 publications

References 11 publications

Predictors of survival after cardiac or respiratory arrest in critical care units

Predictors of survival after cardiac or respiratory arrest in critical care units

Part 8: Advanced Life Support

Survival after in-hospital cardiopulmonary resuscitation

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