Resuscitation in the hospital: Differential relationships between age and survival across rhythms

Parish, David C.; Dane, Francis C.; Montgomery, Meryl; Wynn, Lisa J.; Durham, Marcus D.

doi:10.1097/00003246-199910000-00010

Cited by 38 publications

(16 citation statements)

References 24 publications

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“…Previous clinical reports have focused largely on the SCA event, attributing manifestation of PEA to a variety of factors including hypoxia, hypovolemia, electrolyte imbalance, tamponade, pneumothorax, and thromboembolism. 27 Consistent with several earlier reports in the literature, 18,28,29 we observed that pulmonary disease was associated with increased frequency of PEA.…”

Section: Discussionsupporting

confidence: 91%

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

et al. 2010

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Background— Corresponding with a continuing decline in the prevalence of sudden cardiac arrest cases presenting with ventricular fibrillation (VF), there has been a significant rise in the prevalence of pulseless electrical activity (PEA). Given significantly lower survival from PEA versus VF, we comprehensively investigated PEA correlates by incorporating first-responder data with lifetime clinical history information. Methods and Results— In the Portland, Ore, metropolitan area (population ≈1 million), cases of out-of-hospital sudden cardiac arrest who underwent attempted resuscitation were identified prospectively (2002–2007). Those presenting with PEA versus VF and asystole were compared with χ 2 tests, ANOVA, and logistic regression. A total of 1277 cases aged ≥18 years underwent resuscitation by first responders (mean age, 65±16 years; 67% male). Presenting arrhythmia was VF in 48%, PEA in 25%, and asystole/other in the remainder. Compared with VF cases, PEA cases were older (mean age, 68 versus 63 years; P =0.0002), more likely to be female (37% versus 26%; P =0.0008), and less likely to survive to hospital discharge (6% versus 25%; P <0.0001). A history of syncope was strongly associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.3) after adjustment for age, gender, response time, and arrest circumstances. Black race was also independently associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.4). Pulmonary disease and female gender were significant factors associated with PEA ( P for interaction=0.04). In a subgroup analysis of resting ECGs (n=391), there were no differences in cardiac clinical history or prevalence of cardiac conduction system disease (PEA, 31.6% versus VF, 32.2%; P =0.48). Conclusions— PEA cases had a significantly higher prevalence of syncope in their lifetime, with other correlates, including black race, that were distinct from VF cases. Potential mechanistic links between syncope and future manifestation with PEA warrant further exploration.

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Section: Discussionsupporting

confidence: 91%

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

et al. 2010

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“…Neurological outcomes were comparable between groups. The better survival in patients presenting in VT/VF has been reported for in-hospital arrests by a number of other investigators (23)(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 60%

A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy

Zafari

Zarter

Heggen

et al. 2004

Journal of the American College of Cardiology

101

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“…Similar observation can be found in the literature. Age, used as a continuous variable, was strongly related to survival (odds ratio = 0.984; P < 0.0001) in a study by Parish et al 17,18 Presence of comorbidities prevented successful outcome after CPR. A survival rate of 64% has been shown in out audit in patients with no co-morbidities.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

Chakravarthy

Mitra

Nonis

2012

Indian Heart Journal

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Objective: Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. Aims of the audit:To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit.Methods: This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from 'code blue'. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations.Results: Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. Conclusion:A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval.

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Resuscitation in the hospital: Differential relationships between age and survival across rhythms

Cited by 38 publications

References 24 publications

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

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