Factors influencing outcomes after cardiopulmonary resuscitation in emergency department

Abstract

BACKGROUND:The outcome of cardiopulmonary resuscitation (CPR) may depend on a variety of factors related to patient status or resuscitation management. To evaluate the factors influencing the outcome of CPR after cardiac arrest (CA) will be conducive to improve the effectiveness of resuscitation. Therefore, a study was designed to assess these factors in the emergency department (ED) of a city hospital.METHODS:A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011. The outcomes of CPR were compared in various factors groups. The primary outcomes were rated to return of spontaneous circulation (ROSC), 24-hour survival, survival to discharge and discharge with favorable neurological outcomes. Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival.RESULTS:A total of 725 patients were analyzed in the study. Of these patients, 187 (25.8%) had ROSC, 100 (13.8%) survived for 24 hours, 48 (6.6%) survived to discharge, and 23 (3.2%) survived to discharge with favorable neurologic outcomes. A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology, first monitored rhythms, CPR duration, and total adrenaline dose. The independent predictors of 24-hour survival included traumatic etiology, cardiac etiology, first monitored rhythm and CPR duration. Previous status, cardiac etiology, first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge.CONCLUSIONS:Shockable rhythms, CPR duration ≤15 minutes and total adrenaline dose ≤5 mg were favorable predictors of ROSC, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms and CPR duration ≤15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms, CPR duration ≤15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge, but previous terminal illness or multiple organ failure (MOF) was unfavorable.

Witnessed Cardiac Arrest by Nigerian Health Workers; Improving the Outcomes

“…The success was attributed to immediate recognition, prompt CPR, oxygen therapy and fl uid therapy in that order. Other researchers have reported that witnessed arrests and shorter time of CPR were associated with higher survival rates when compared to unwitnessed arrests or a longer duration of resuscitation [27,28].…”

Making sense of clinical outcomes following cardiac arrest

“…In a study of 725 patients, Xue et al demonstrated that 97.8% of patients with CPR lasting at least 15 min achieved ROSC, with a 36% survival to discharge and 20.2% favorable neurological outcomes. CPR more than 15 min was, however, associated with ROSC in only 15.7%, with a 2.5% survival to discharge and 0.8% favorable neurological outcomes [7]. A cutoff of 15 min as a predictor of ROSC and longer-term survival has been observed in many other studies.…”

“…A number of recent studies have demonstrated that prolonged cardio-pulmonary resuscitation (CPR) is associated with poor survival and neurological outcomes [4,[7][8][9]. In a study of 725 patients, Xue et al demonstrated that 97.8% of patients with CPR lasting at least 15 min achieved ROSC, with a 36% survival to discharge and 20.2% favorable neurological outcomes.…”

Mass Gathering Medicine (Hajj Pilgrimage in Saudi Arabia): The Outcome of Cardiopulmonary Resuscitation during Hajj

“…Therefore, the current clinical resuscitation research of focuses mainly on influencing the factors affecting the CPR outcomes and increasing the resuscitation effectiveness [10]. Cardiac etiology, shockable rhythms, CPR duration ≤ 15 min, and total adrenaline dose ≤ 5 mg were suggested as predictors of a favorable outcome, whereas traumatic etiology, previous terminal illness, or multiple organ failures were predictors of an unfavorable outcome [11].…”