IN-HOSPITAL CARDIOPULMONARY RESUSCITATION: THREE YEARS EXPERIENCE –LESSONS AND RESULTS

Abstract

PURPOSE: To investigate the factors affecting the outcome of in-hospital patients who sustained cardiopulmonary-arrest in various hospital units (floor, telemetry, ICU/CCU). METHODS: Retrospective chart-review of 95-patients with in-hospital code-blue over 3-years. Inclusion-criteria: in-hospital documented cardiopulmonary-arrest with pulseless-patients. Exclusioncriteria: DNR, out-of-hospital CPR and incomplete chart-documentation. Patients were divided in 3-groups according to location of first-CPR: ICU/CCU, telemetry, general-medical/surgical ward. Data abstracted include: demographics, type of arrest, location of arrest, time of arrest(day or night), comorbidities, CPR-duration, length-of-stay (LOS), early-outcome (at end of first code) and late-outcome (at end of hospitalization), neurological-outcome of survivals and need for prolonged-mechanical ventilation. RESULTS: 95 patients:floor-codes: 40 (42%), ICU-codes: 18 (19%), telemetry: 37(39%). Mean-age: 66.5, gender: Male (53%)-female (47%), mean-hospital-LOS 10.1 days, mean-ICU-LOS 3.9 days. In early-outcome analysis (end-of-code): 27 out of 95 died (28% mortality rate); time of CPR: 18 out of 61 daytime died vs. 9 out of 34 nighttime CPR died (P-value=0.753). Code-location: 12 out of 40 floorcodes died (30%), 6 out of 18 ICU-codes died (33%), 9 out of 37 telemetry-codes died (24%)(p=0.753). Arrest-type: asystole 11 out of 36 died (30%), PEA 8 out of 34 died (23%), VF/VT 2 out of 10 died (20%) (p-value=0.71). 70% of dead were males vs.30% were females (p = 0.029). Mean-duration of CPR: among-survivals: 18.0 minutes, among-dead: 23.7 minutes (p=0.030). Final-Outcome Analysis (end-of-hospitalization): 75 out of 95 died (79% mortality rate); 45% of survivals were ventilatordependent, 45% of survivals had encephalopathy, 53% of dead were males vs. 47% were females (p= 0.807), mean-age: 65.2 years among survivals and 66.9 years dead ones(p=0.579), mean-duration of CPR: among-survivals 13.0 minutes, among-dead 21.4 minutes (p=0.004), type of arrest: asystole 32 out of 36 died (88%), PEA 27 out of 34 died (79%), VF/VT 6 out of 10 died (60%) (P=0.10). CONCLUSION: CPR is associated with poor final outcome in general (high mortality and morbidity). Factors predicting early survival from CPR: Gender (female), mean-duration of CPR (18-minutes or less). Factors predicting final survival from CPR: mean-duration of CPR (13-minutes or less). Age, time (daytime Vs. nighttime), type of arrest and location of CPR had no impact on final-outcome. CLINICAL IMPLICATIONS: Prolonging CPR beyond 15 to 20 minutes may not be appropriate as that maybe associated with poor outcome.