In‐hospital cardiopulmonary resuscitation

Skogvoll, Eirik; Isern, Erik Ramon; Sangolt, G. K.; Gisvold, Sven Erik

doi:10.1034/j.1399-6576.1999.430210.x

Cited by 116 publications

(29 citation statements)

References 28 publications

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“…This definition of CPR within Medicare data has not been validated and short of a long and expensive prospective study cannot be validated. We are reassured that our definition is reasonably accurate as our overall survival among all patients receiving CPR was 18.4%, a figure similar to several prior studies [10,12,13,19,30,31]. Additionally, our finding that 10.1% of ventilated patients receiving CPR survive to hospital discharge is almost similar to the prior NRCPR study [10], again indicating that our definition within Medicare data is adequate.…”

Section: Discussionsupporting

confidence: 86%

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Cardiopulmonary resuscitation among mechanically ventilated patients

et al. 2014

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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.

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Section: Discussionsupporting

confidence: 86%

“…Thus, we cannot be certain that outcomes in Medicare beneficiaries have not also improved since 2005. Finally, we do not know the initial arrest rhythm, which is an important variable associated with survival [34], as survival rates are highest among patients with ventricular tachycardia or fibrillation [11-13,16,30,31,34,36-38]. …”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary resuscitation among mechanically ventilated patients

et al. 2014

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“…elderly) or hospital location (e.g. non-ICU setting) (4, 23) Other reports vary in terms of cumulative event rate at a group of hospitals compared with event rate at individual facilities (3, 4, 12, 23). The definitions for treated IHCA and event rate also varied widely (5, 6).…”

Section: Discussionmentioning

confidence: 99%

Incidence of treated cardiac arrest in hospitalized patients in the United States*

Merchant

Yang

Becker

et al. 2011

Critical Care Medicine

383

212

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Objective The incidence and incidence over time of cardiac arrest in hospitalized patients (IHCA) is unknown. We sought to estimate the event rate and temporal trends of adult inhospital cardiac arrest (IHCA) treated with a resuscitation response. Design Three approaches were used to estimate the IHCA event rate. First approach: Calculate the IHCA event rate at hospitals (n=433) in the Get With The Guidelines-Resuscitation (GWTG-R) registry, years 2003–2007 and multiply this by US annual bed-days. Second approach: Use the GWTG-R, IHCA event rate to develop a regression model (including hospital demographic, geographic, organizational factors) and use the model coefficients to calculate predicted event rates for acute care hospitals (n=5,445) responding to the American Hospital Association survey. Third approach: Classify acute care hospitals into groups based on academic, urban, bed size-and determine the average event rate for GWTG-R hospitals in each group and then use weighted averages to calculate the national IHCA rate. Annual event rates were calculated to estimate temporal trends. Setting GWTG-R registry Patients Adult IHCA with a resuscitation response Measurements and main results The mean adult treated IHCA event rate at GWTG-R hospitals was 0.92/1000 bed-days (IQR 0.58 to 1.2/1000). In hospitals (n=150) contributing data for all years of the study period, the event rate increased from 2003–2007. With 2.09 million annual US bed-days, we estimated 192,000 IHCA throughout the US annually. Based on the regression model, extrapolating GWTG-R hospitals to hospitals participating in the American Hospital Association survey projected 211,000 annual IHCA. Using weighted averages projected 209,000 annual US IHCA. Conclusions There are approximately 200,000 treated cardiac arrests among US hospitalized patients annually and this rate may be increasing. This is important for understanding the burden of IHCA and developing strategies to improve care for hospitalized patients.

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“…[3][4][5][6][7] Reported incidence for IHCA varies from 1 to 3.8 events per 1000 hospital admissions, while survival to hospital discharge ranges from 6.6% to 42%. [8][9][10][11][12] Part of the variability is undoubtedly due to differing inclusion criteria and do-not-resuscitate (DNR) policies. Nevertheless, it has been shown that socioeconomic status of the victim and location of CA influences bystander cardiopulmonary resuscitation (CPR) rates and survival from CA.…”

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confidence: 99%