Cardiopulmonary resuscitation among mechanically ventilated patients

Abstract

Purpose To evaluate the outcomes, including long term survival, after CPR in mechanically ventilated patients. Methods We analyzed Medicare data from 1994-2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated (defined by ICD-9 procedure code for intubation [96.04] or mechanical ventilation [96.7x] one or more days prior to procedure code for CPR [99.60 or 99.63]). Results We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4% (95% confidence interval [CI] 18.3-18.5%). Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1% (95% CI 9.8%-10.4%), compared to 19.2% (95% CI 19.1%-19.3%) in non-ventilated patients (p<0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52% lower odds of survival (OR 0.48, 95% CI 0.46-0.49, p<0.001). Median long term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95% CI 5.3-6.8 months), compared to 19.0 months (95% CI 18.6-19.5 months) among the non-ventilated survivors (p=<0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1% were alive at one year. Conclusions Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.

Real-time compression feedback for patients with in-hospital cardiac arrest: a multi-center randomized controlled clinical trial

“…However, data from a large administrative database study (25,006 cardiopulmonary arrest events) found that early invasive airway insertion was not associated with improved ROSC rates, and only slightly better odds of 24 h survival (adjusted OR 0.94, 0.89–0.99) [59]. Moreover, data from both non-randomized clinical studies [47] and large administrative database [60] studies have reported that patients who were already intubated or had received mechanical ventilation before resuscitation had reduced ROSC and survival. We performed both intra- and inter-group comparisons to further assess the impact of intubation on resuscitation outcome.…”

The Relationship Among Obesity, Nutritional Status, and Mortality in the Critically Ill*

“…We applied the serum creatinine criteria only to determine the maximum RIFLE class (57). Mechanical ventilation was defined by the presence of ICD-9-CM code 96.7× during hospitalization (59). RIFLE class was determined in patients with preadmission baseline creatinine available from 7 to 365 days prior to hospital admission with the creatinine closet to hospital admission recorded.…”

Year in review in Intensive Care Medicine 2014: I. Cardiac dysfunction and cardiac arrest, ultrasound, neurocritical care, ICU-acquired weakness, nutrition, acute kidney injury, and miscellaneous

“…Al-Alwan et al [ 14 ] reported the incidence and prognosis of CPR among patients already on mechanical ventilation using patient data in the Finnish medicare database between January 1994 and December 2005. Among the 471,962 patients who received in-hospital CPR during the period, 18.4 % survived.…”