Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results.

Abstract

Objective-To determine the circumstances, incidence, and outcome of cardiopulmonary resuscitation in British hospitals.Design-Hospitals registered all cardiopulmonary resuscitation attempts for 12 months or longer and followed survival to one year.Setting-12 metropolitan, provincial, teaching, and non-teaching hospitals across Britain.Subjects-3765 patients in whom a resuscitation attempt was performed, including 927 in whom the onset of arrest was outside the hospital.Main outcome measure-Survival after initial resuscitation, at 24 hours, at discharge from hospital, and at one year, calculated by the life Conclusion-71% of the mortality at one year in patients undergoing attempted resuscitation occurred during the initial arrest. Hospital resuscitation is life saving and cost effective and warrants appropriate attention, training, coordination, and equipment. IntroductionThe United Kingdom Resuscitation Council was established in 1982 to foster improved knowledge and practice of cardiopulmonary resuscitation. At this time the subject was comparatively neglected in Britain compared with the United States.' 2 As part of a wider programme'-5 the council organised a multicentre study of the circumstances, incidence, and outcome of cardiopulmonary resuscitation in hospital aimed at determining what is happening in a part of hospital practice not covered by routine statistics; developing a standard method of recording arrests that could be used for audit, clinical trials, and, possibly, community studies; and providing a British baseline against which results from other countries, changing management, and future surveys could be assessed.6 This first paper describes the methods and overall results, with survival followed to one year. Detailed analysis of subgroups will be reported elsewhere.

Survival after in-hospital cardiopulmonary resuscitation

“…The subset of 10 studies meeting the strict inclusion criteria included 2,434 patients. Among the 41 studies that met the minimal criteria, 12 took place in Europe, 13,15,17,19,28,31,38,[40][41][42][43][44]48 one each in Australia, 22 Israel, 24 and Japan, 30 12 (1983) 294 All adults Y x x x Gulati et al 13 (1983) 52 Adults Ն age 64 N x Scaff et al 14 (1984) 242 All adults N x x Sowden et al 15 (1984) 108 All adults N x ? ?…”

“…However, only six studies were identified in a review of the literature that reported results for more than 500 patients, and only one included more than 1,000 patients. 10,36,41,43,47,56 Therefore, the majority of studies have had inadequate sample size to identify important predictors of the outcome of in-hospital CPR. Although smaller studies have shown relations between pre-arrest variables and the outcome of CPR, those associations have been inconsistent.…”

“…48,56 One study was excluded because only a single patient met the inclusion criteria. 49 Four of the studies included in the analysis either children 31,41 or out-of-hospital arrests, 41,42 but presented their data in such a way that these nonqualifying cases could be excluded from the analysis. A total of 41 studies met the minimal inclusion criteria, while only 10 studies met the strict inclusion criteria.…”

The 1998 European Resuscitation Council guidelines for adult advanced life support

“…[11][12][13][14] The overwhelming majority of eventual survivors come from this group. [15][16][17][18] If the definitive treatment for these arrhythmias-defibrillation-can be implemented promptly a perfusing cardiac rhythm may be restored and lead to long term survival. The only interventions that have been shown unequivocally to improve long term survival are basic life support and defibrillation.…”

Pediatric Sudden Cardiac Arrest

“…The published outcomes for outof-hospital pediatric cardiac arrest are dismal; survival to hospital discharge occurs in approximately <10% of children, and many have severe neurologic sequelae. [59][60][61][62][63] Poor outcomes may be related to prolonged periods of no cardiac output, in part because many out-of-hospital arrests are unwitnessed, and only approximately 30% of children received bystander CPR 61 (note also that bystander CPR more than doubles patient survival rates 64 ).…”