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 [OR] 31.3; 95% confidence interval [CI] 1.9, 515), metastatic cancer (OR 3.9; 95% CI 1.2, 12.6), dementia (OR 3.1; 95% CI 1.1, 8.8), African-American race (OR 2.8; 95% CI 1.4, 5.6), serum creatinine level at a cutpoint of 1.5 mg/dL (OR 2.2; 95% CI 1.2, 3.8), cancer (OR 1.9; 95% CI 1.2, 3.0), coronary artery disease (OR 0.55; 95% CI 0.4, 0.8), and location of resuscitation in the intensive care unit (OR 0.51; 95% CI 0.4, 0.8). CONCLUSIONS:When talking with patients, physicians can describe the overall likelihood of surviving discharge as 1 in 8 for patients who undergo cardiopulmonary resuscitation and 1 in 3 for patients who survive cardiopulmonary resuscitation.

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From 1974 through 1978, 557 patients (mean age: 63 years) underwent Dacron® graft replacement of the abdominal aorta at the Cleveland Clinic. Postoperative complications occurred in 110 patients (20%), with mortality rates of 5.1% for those having intact aortic aneurysms, 26% for those with ruptured aneurysms, and 2.3% for those with aortoiliac occlusive disease. Myocardial infarction was the most common cause of postoperative death, affecting 3.1% of the entire series, but all 87 patients who had previously required myocardial revascularization survived subsequent aortic procedures (p < 0.01). As defined in this investigation, temporary renal failure (7.0%) or pulmonary insufficiency (5.9%) were encountered more frequently than were other complications, but each of these was the singular cause of death in only 0.2% of all patients. Several risk factors significantly influenced postoperative mortality, (p < 0.01), including age over 60 years, suspected coronary artery disease, serum creatinine greater than 2.0 mg/dl, complementary renal artery revascularization, and aneurysm rupture. In addition, intraoperative blood loss had a statistically valid correlation with postoperative mortality (p < 0.01), myocardial infarction (p <0.01), renal failure (p <0.001), and pulmonary insufficiency (p < 0.001). pOSTOPERATIVE COMPLICATIONS after major arterial operations are inevitable in some patients with severe systemic atherosclerosis. The safety of peripheral vascular procedures is commonly compromised by advanced age, diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and impaired renal function.' Despite the fact that these risk factors are heavily concentrated among patients who have abdominal aortic aneurysms or aortoiliac occlusive disease, reports from some respected vascular surgical centers have described operative mortality rates of less than 3% for elective aortic replacement as well as remarkable improvement in survival after resection ofruptured aneurysms.5'8 Published data concerning 2,088 abdominal aortic operations entered in the computer registry of the Cleveland Vascular Society, however, indicate that the exceptional results

SUBSTITUTES for whole blood include fractions of blood, such as plasma, serum albumin, and true substitutes such as the plasma volume expanders and intravenous crystalloid solutions. BACKGROUNDCzerny reported in 1894 ~ on the intravenous injection of colloids in animals, after giving gum arabic or gelatin to dogs, cats, and rabbits. He found an increase of blood viscosity after giving gum arabic and decreased RBC count after colloid injection. Hogan in 1915 first used colloidal gelatin intravenously with improvement in blood pressure of patients in shock. '-' In 1918 Bayliss treated wound shock for the first time with gum acacia? Many of the patients improved; those who did not also did not respond to transfusion of blood. Gronwall and Ingelman reported their work with dextrin in 1945 and advocated it as appropriate for treatment of shock? It has been in clinical use ever since. ESSENTIALS OF AN ACCEPTABLE PLAS~,IA SUBSTITUTEMajor considerations ~ are that it must maintain a satisfactory colloidal osmotic pressure, be capable of manufacture at a constant composition and reasonable price, be stable in storage and on exposure to wide variations in temperature, be easily sterilized by autoclaving and have a suitable viscosity for intravenous administration. It must be pyrogen flee, be excreted or metabolized without damage to tissues and not be antigenic. Another factor is that it should remain in the vascular compartment for 12 to 24 hours. ' It should not produce haemolysis, red blood cell agglntination, or increased sedimentation rate. It should not alter other functions of the blood, or impair haemostasis. Advantages of Plasma SubstitutesSubstances capable of expanding plasma volume are of critical importance in dealing with disasters involving many casualties and with less emergent needs in remote areas where blood is not availabled Non-biological substitutes for blood can be manufactured in large quantities and stored for long periods of time. In many cases of shock there is need for increase of circulating volume, while sufficient red cells are still present for adequate carriage of oxygen. The risks of blood transfusion are the advantages of plasma substitutes: avoidance of bacterial or viral infection, transfusion reactions and Rh sensitization. With plasma substitutes, one