Predicting in-hospital mortality during cardiopulmonary resuscitation

Schultz, Scot C.; Cullinane, Daniel C.; Pasquale, Michael D.; Magnant, Colette; Evans, Stephen

doi:10.1016/s0300-9572(96)00986-0

Cited by 143 publications

(34 citation statements)

References 28 publications

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“…Different studies reported controversial results as regards the influence of CPR duration on the outcome. Schultz et al 20 described CPR efforts beyond 10 min as one of the poor prognostic factors after IHCA. A more recent study 21 found that the rate of achieving ROSC was >90% among patients resuscitated <10 min compared to approximately 50% for those resuscitated P30 min and the cumulated discharge survival rate was 90% in patients with CPR duration <30 min.…”

Section: Discussionmentioning

confidence: 99%

Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

Taha

Bakhoum

Kasem

et al. 2015

The Egyptian Heart Journal

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Introduction: High quality cardiopulmonary resuscitation (CPR) performed according to international guidelines has a vital impact on survival of cardiac arrest. Objective: To investigate different variables affecting return of spontaneous circulation (ROSC) and survival to discharge (STD) after in-hospital cardiac arrest (IHCA) and evaluate adherence to CPR guidelines using a modified Utstein-style template. Methods: A prospective observational study of 126 IHCA out of 5479 admissions to cardiology units of 3 Cairo University hospitals. Results: CPR was not attempted in 7 futile cases. ROSC was achieved in 50.4%, while STD was achieved in only 7.6% of 119 attempted resuscitations. CPR was started by a physician in 114 cases (95.8%) and by the on duty nurse in only 5 cases. The initial rhythm was shockable rhythm (SR) in 19 cases; 13 (68.4%) of whom achieved ROSC and 6 (31.6%) STD and non SR (pulseless electric This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). activity/asystole) in 100 cases; 47 (47%) of whom achieved ROSC and 3 (3%) STD. Chest compressions were observed appropriate P100/min, P2 inches deep and interrupted <10 s in 99.2%, 92.4% and 48.7% of cases respectively. Initial SR and duration of CPR were independently associated with ROSC (both P = 0.01) and STD (P = 0.008 and 0.02 respectively). A cut-off value for CPR duration of 22.5 min had a sensitivity of 86.7% and a specificity of 81.4% in predicting ROSC by receiver-operator characteristics analysis. Conclusion: The poor STD despite a relatively good ROSC calls for improvement of CPR education and training for hospital personnel and better post CA care.

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Section: Discussionmentioning

confidence: 99%

Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

Taha

Bakhoum

Kasem

et al. 2015

The Egyptian Heart Journal

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“…Despite the progress, results of applying life support measures remain limited, with survival rates from 8.2 to 22% among all hospitalized patients and from 6 to 11% among critically ill patients (2)(3)(4)(5). Patients undergoing life support measures for more than 10-15 min without return of systemic circulation (ROSC) show a rapid decline in chances of survival over time (6)(7)(8)(9). These chastening outcome data make a strong case for extended measures to stabilize hemodynamics and consequently improve survival.…”

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confidence: 99%

Single‐Center Experience With Extracorporeal Life Support in 103 Nonpostcardiotomy Patients

Schopka¹,

Philipp²,

Lunz³

et al. 2013

Artificial Organs

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Extracorporeal membrane oxygenation (ECMO) has been successfully used to support patients with cardiac arrest failing to respond to conventional cardiopulmonary resuscitation (CPR). Preimplant factors being indicative for success are unknown up to now. The study describes single center experience with special focus on differences between survivors and nonsurvivors. Between 2002 and 2009, 103 patients were supported within the scope of CPR by means of ECMO. Besides primary diagnosis, duration, and outcome, pH, lactate, mean arterial pressure, aspartate aminotransferase, bilirubin, catecholamine dosage, and oxygenation ratio before ECMO, after 2 h, 1 day, and at explantation were analyzed. One hundred three patients (51.2 ± 16 years, 35 women, 68 men) were analyzed. Primary cardiac failure led to CPR in 54%. Duration of support was 4.8 ± 0.6 days. Twenty-nine (28.1%) patients survived to hospital discharge. On ECMO support, pH, lactate, and mean arterial pressure improved significantly. Catecholamine dosage was significantly reduced after ECMO implantation. Demographic data and primary diagnosis revealed no significant influence on outcome. pH, lactate, creatinine, and bilirubin differed significantly between survivors and nonsurvivors in the course of ECMO support. ECMO support during CPR reliably improves the circulatory and respiratory situation. Considering observed survival critical patient selection is mandatory. Although there are several significant differences between surviving patients and patients with fatal outcome, patient selection turns out to be difficult as clinically relevant factors show only limited predictive value. Future research should focus on better defining a population that may be best of all suited for the use of ECMO support in CPR.

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“…13-15,17 Laurent et al 21 identified a longer time interval as a risk factor for hemodynamic instability after ROSC, and Jorgensen 22 demonstrated that cardiac arrest patients requiring CPR for more than 20 minutes rarely survived. However, these studies were done before TH was the standard of care, and thus outcome in patients requiring prolonged resuscitation who are treated with TH remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

et al. 2014

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Background Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. Methods This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. Results 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0–32.3) minutes and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10 min, 11-20 min, 21-30 min, > 30 min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20 minutes, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Conclusions Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime > 20 minutes.

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Predicting in-hospital mortality during cardiopulmonary resuscitation

Cited by 143 publications

References 28 publications

Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

Quality of cardiopulmonary resuscitation of in-hospital cardiac arrest and its relation to clinical outcome: An Egyptian University Hospital Experience

Single‐Center Experience With Extracorporeal Life Support in 103 Nonpostcardiotomy Patients

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

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