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Incidence, characteristics and predictors of mortality following cardiac arrest in ICUs of a German university hospital: A retrospective cohort study. Eur J Anaesthesiol 2022; 39:452-462. [PMID: 35200202 DOI: 10.1097/eja.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac arrest in intensive care is a rarely studied type of in-hospital cardiac arrest. OBJECTIVE This study examines the incidence, characteristics, risk factors for mortality as well as long-term prognosis following cardiac arrest in intensive care. DESIGN Retrospective cohort study. SETTING Five noncardiac surgical ICUs (41 surgical and 37 medical beds) at a German university hospital between 2016 and 2019. PATIENTS Adults experiencing cardiac arrest defined as the need for chest compressions and/or defibrillation occurring for the first time on the ICU. MAIN OUTCOME MEASURES Primary endpoint: occurrence of cardiac-arrest in the ICU. Secondary endpoints: diagnostic and therapeutic measures; risk factors and marginal probabilities of no-return of spontaneous circulation; rates of return of spontaneous circulation, hospital discharge, 1-year-survival and 1-year-neurological outcome. RESULTS A total of 114 cardiac arrests were observed out of 14 264 ICU admissions; incidence 0.8%; 95% confidence interval (CI) 0.7 to 1.0; 45.6% received at least one additional diagnostic test, such as blood gas analysis (36%), echocardiography (19.3%) or chest x-ray (9.9%) with a resulting change in therapy in 52%, (more frequently in those with a return of spontaneous circulation vs none, P = 0.023). Risk factors for no-return of spontaneous circulation were cardiac comorbidities (OR 5.4; 95% CI, 1.4 to 20.7) and continuous renal replacement therapy (OR 5.9; 95% CI, 1.7 to 20.8). Bicarbonate levels greater than 21 mmol l-1 were associated with a higher mortality risk in combination either with cardiac comorbidities (bicarbonate <21 mmol l-1: 13%; 21 to 26 mmol l-1: 45%; >26 mmol l-1: 42%) or with a SOFA at least 2 (bicarbonate <21 mmol l-1: 8%; 21 to 26 mmol l-1: 40%; >26 mmol l-1: 37%). In-hospital mortality was 78.1% (n=89); 1-year-survival-rate was 10.5% (95% CI, 5.5 to 17.7) and survival with a good neurological outcome was 6.1% (95% CI, 2.5 to 12.2). CONCLUSION Cardiac arrest in ICU is a rare complication with a high mortality and low rate of good neurological outcome. The development of a structured approach to resuscitation should include all available resources of an ICU and adequately consider the complete diagnostic and therapeutic spectra as our results indicate that these are still underused. The development of prediction models of death should take into account cardiac and hepatic comorbidities, continuous renal replacement therapy, SOFA at least 2 before cardiac arrest and bicarbonate level. Further research should concentrate on identifying early predictors and on the prevention of cardiac arrest in ICU.
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Survival after in-hospital cardiac arrest among cerebrovascular disease patients. J Clin Neurosci 2018; 54:1-6. [PMID: 29789199 DOI: 10.1016/j.jocn.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 11/20/2022]
Abstract
Stroke is a leading cause of death and disability, and while preferences for cardiopulmonary resuscitation (CPR) are frequently discussed, there is limited evidence detailing outcomes after CPR among acute cerebrovascular neurology (inclusive of stroke, subarachnoid hemorrhage (SAH)) patients. Systematic review and meta-analysis of PubMed and Cochrane libraries from January 1990 to December 2016 was conducted among stroke patients undergoing in-hospital CPR. Primary data from studies meeting inclusion criteria at two levels were extracted: 1) studies reporting survival to hospital discharge after CPR with cerebrovascular primary admitting diagnosis, and 2) studies reporting survival to hospital discharge after CPR with cerebrovascular comorbidity. Meta-analysis generated weighted, pooled survival estimates for each population. Of 818 articles screened, there were 176 articles (22%) that underwent full review. Three articles met primary inclusion criteria, with an estimated 8% (95% Confidence Interval (CI) 0.01, 0.14) rate of survival to hospital discharge from a pooled sample of 561 cerebrovascular patients after in-hospital CPR. Twenty articles met secondary inclusion criteria, listing a cerebrovascular comorbidity, with an estimated rate of survival to hospital discharge of 16% (95% CI 0.14, 0.19). All studies demonstrated wide variability in adherence to Utstein guidelines, and neurological outcomes were detailed in only 6 (26%) studies. Among the few studies reporting survival to hospital discharge after CPR among acute cerebrovascular patients, survival is lower than general inpatient populations. These findings synthesize the limited empirical basis for discussions about resuscitation among stroke patients, and highlight the need for more disease stratified reporting of outcomes after inpatient CPR.
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Nichol G, Guffey D, Stiell IG, Leroux B, Cheskes S, Idris A, Kudenchuk PJ, Macphee RS, Wittwer L, Rittenberger JC, Rea TD, Sheehan K, Rac VE, Raina K, Gorman K, Aufderheide T. Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy. Resuscitation 2015; 93:74-81. [PMID: 26025570 DOI: 10.1016/j.resuscitation.2015.05.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022]
Abstract
IMPORTANCE Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. DESIGN Prospective cohort sub-study of a randomized trial. SETTING The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. PARTICIPANTS Consenting survivors to discharge. MAIN OUTCOME MEASURES Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). RESULTS Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. CONCLUSIONS AND RELEVANCE The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.
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Affiliation(s)
- Graham Nichol
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States; University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States.
| | - Danielle Guffey
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Brian Leroux
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Sheldon Cheskes
- Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital and Sunnybrook Center for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahamed Idris
- Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Peter J Kudenchuk
- King County EMS, Seattle and King County Public Health, and Department of Medicine, University of Washington, Seattle, WA, United States
| | | | - Lynn Wittwer
- Clark County Emergency Medical Services, Vancouver, WA, United States
| | - Jon C Rittenberger
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Thomas D Rea
- King County EMS, Seattle and King County Public Health, and Department of Medicine, University of Washington, Seattle, WA, United States
| | - Kellie Sheehan
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Val E Rac
- Toronto Health Economics and Technology Assessment Collaborative, Institute of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Keitki Raina
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kyle Gorman
- Clackamas Fire District #1, Clackamas, OR, United States
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Temporal trends in cardiac arrest incidence and outcome in Finnish intensive care units from 2003 to 2013. Intensive Care Med 2014; 40:1853-61. [PMID: 25387815 DOI: 10.1007/s00134-014-3509-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To estimate temporal trends in incidence and hospital mortality after cardiac arrest in Finnish intensive care units. METHODS Using a large nationwide intensive care unit (ICU) database we identified patients suffering from cardiac arrest following ICU admission (ICU-CA) during the study period (2003-2013). ICU-CA was defined as need for cardiopulmonary resuscitation and/or defibrillation (non-arrest cardioversions were excluded) according to the Therapeutic Intervention Scoring System-76. Patients admitted with an admission diagnosis of cardiac arrest were excluded. We determined crude incidence and risk-adjusted hospital mortality (based on a customized severity of illness model) for all ICU-CA patients, and for predefined admission diagnosis subgroups. Temporal trends for the observed period were calculated for crude incidence and risk-adjusted hospital mortality. RESULTS Crude incidence for all ICU-CA patients was 29/1,000 ICU admissions, with the highest incidence 118/1,000 in the non-operative cardiovascular subgroup. Overall hospital mortality for ICU-CA patients was 55.5% [95% confidence interval (CI) 54-57%]. Hospital mortality was 53.1% (95% CI 50.4-55.8%) for non-operative cardiovascular ICU-CA patients, 32.9% (95% CI 26.9-38.9%) for post cardiac surgery ICU-CA patients, and 56.3% (95% CI 51.2-61.3%) for neurological/neurosurgical ICU-CA patients. There was a significant reduction in the overall ICU-CA incidence and in the risk-adjusted hospital mortality of ICU-CA and non-cardiac arrest cases (non-CA) over the observed study period (p < 0.001). CONCLUSION Our data suggest that the incidence of ICU-CA has decreased in Finnish ICUs between 2003 and 2013. Similar reduction in hospital mortality over time was observed for both ICU-CA and non-CA populations.
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Rozen TH, Mullane S, Kaufman M, Hsiao YFF, Warrillow S, Bellomo R, Jones DA. Antecedents to cardiac arrests in a teaching hospital intensive care unit. Resuscitation 2014; 85:411-7. [DOI: 10.1016/j.resuscitation.2013.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/07/2013] [Accepted: 11/16/2013] [Indexed: 11/26/2022]
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Efendijev I, Nurmi J, Castrén M, Skrifvars MB. Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature. Resuscitation 2014; 85:472-9. [PMID: 24412160 DOI: 10.1016/j.resuscitation.2013.12.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Significant amount of data on the incidence and outcome of out-of-hospital and in-hospital cardiac arrest have been published. Cardiac arrest occurring in the intensive care unit has received less attention. AIMS To evaluate and summarize current knowledge of intensive care unit cardiac arrest including quality of data, and results focusing on incidence and patient outcome. SOURCES AND METHODS We conducted a literature search of the PubMed, CINAHL and Cochrane databases with the following search terms (medical subheadings): heart arrest AND intensive care unit OR critical care OR critical care nursing OR monitored bed OR monitored ward OR monitored patient. We included articles published from the 1st of January 1990 till 31st of December 2012. After exclusion of all duplicates and irrelevant articles we evaluated quality of studies using a predefined quality assessment score and summarized outcome data. RESULTS The initial search yielded 794 articles of which 780 were excluded. Three papers were added after a manual search of the eligible studies' references. One paper was identified manually from the literature published after our initial search was completed, thus the final sample consisted of 18 papers. Of the studies included thirteen were retrospective, two based on prospective registries and three were focused prospective studies. All except two studies were from a single institution. Six studies reported the incidence of intensive care unit cardiac arrest, which varied from 5.6 to 78.1 cardiac arrests per 1000 intensive care unit admissions. The most frequently reported initial cardiac arrest rhythms were non-shockable. Patient outcome was variable with survival to hospital discharge being in the range of 0-79% and long-term survival ranging from 1 to 69%. Nine studies reported neurological status of survivors, which was mostly favorable, either no neurological sequelae or cerebral performance score mostly of 1-2. Studies focusing on post cardiac surgery patients reported the best long-term survival rates of 45-69%. CONCLUSIONS At present data on intensive care unit cardiac arrest is quite limited and originates mostly from retrospective single center studies. The quality of data overall seems to be poor and thus focused prospective multi-center studies are needed.
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Affiliation(s)
- Ilmar Efendijev
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland.
| | - Jouni Nurmi
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland
| | - Maaret Castrén
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, University of Turku, Finland
| | - Markus B Skrifvars
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland
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Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest. Resuscitation 2011; 82:1036-40. [PMID: 21524837 PMCID: PMC3138855 DOI: 10.1016/j.resuscitation.2011.03.034] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 03/29/2011] [Accepted: 03/31/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition are commonly used to determine outcomes following cardiac arrest. This study tested the association between these outcome measures. METHODS Retrospective chart review of subjects who survived to hospital discharge between 1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS, and discharge disposition). Discharge disposition was classified in 6 categories: home with no services, home with home healthcare, acute rehabilitation facility, skilled nursing facility, long term acute care facility, and hospice. Intra-and inter-rater reliabilities were calculated for outcome measures. Rates of "good outcome" (defined as a CPC of 1-2, mRS of 0-3, or discharge disposition to home or acute rehabilitation facility) were also determined. Kendall's tau correlation coefficients explored relationships among measures. RESULTS A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%) were white males, in- and out-of hospital cardiac arrests were equally prevalent, and ventricular dysrhythmia was most common (N=109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%) received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS abstraction was 95.24% (kappa 0.89, p<0.001) and 95.24% (kappa 0.90, p<0.001) respectively. "Good outcomes" were found in 44 subjects (20%) using the CPC definition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects using discharge disposition definition. There was fair relationship between the CPC and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau 0.23) and between mRS and discharge disposition (tau 0.25). CONCLUSIONS Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable from chart review. These instruments provide widely differing estimates of "good outcome". Agreement between these measures ranges from poor to fair. A more nuanced outcome measure designed for the post-cardiac arrest population is needed.
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Affiliation(s)
- Jon C Rittenberger
- University of Pittsburgh, Department of Emergency Medicine, School of Medicine, PA 15261, United States.
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Saevareid TJ, Balandin S. Nurses’ perceptions of attempting cardiopulmonary resuscitation on oldest old patients. J Adv Nurs 2011; 67:1739-48. [DOI: 10.1111/j.1365-2648.2011.05622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chang SH, Huang CH, Shih CL, Lee CC, Chang WT, Chen YT, Lee CH, Lin ZY, Tsai MS, Hsu CY, Ma MHM, Chen SC, Chen WJ. Who survives cardiac arrest in the intensive care units? J Crit Care 2009; 24:408-14. [DOI: 10.1016/j.jcrc.2008.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 09/24/2008] [Accepted: 10/19/2008] [Indexed: 11/15/2022]
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Raina KD, Callaway C, Rittenberger JC, Holm MB. Neurological and functional status following cardiac arrest: method and tool utility. Resuscitation 2008; 79:249-56. [PMID: 18692288 PMCID: PMC2600809 DOI: 10.1016/j.resuscitation.2008.06.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 05/21/2008] [Accepted: 06/04/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assessing the neurological and disability status of cardiac arrest (CA) survivors is important for evaluating the outcomes of resuscitation interventions. The Cerebral Performance Category (CPC)--the standard outcome measurement after CA--has been criticized for its poorly defined, subjective criteria, lack of information regarding its psychometric properties, and poor relationships with long-term measures of disability and quality of life (QOL). This study examined the relationships among the CPC and measures of global disability and QOL at discharge from the hospital and at 1 month after CA. METHODS Twenty-one CA survivors participated in the study. A medical chart review was conducted at the time of discharge to determine CPC and Modified Rankin Scale (mRS) scores, while 1-month in-person interview was conducted to collect mRS and Health Utilities Index Mark 3 (HUI3) scores. Data collected during the interview were used to determine follow-up CPC scores. RESULTS The strength of relationships among measures at discharge and 1 month ranged between fair to good. An examination of scatter plots revealed substantial variability and a wide distribution of chart review and 1-month mRS and HUI3 scores within each CPC category. CPC scores obtained through chart review were significantly better than the CPC 1-month scores, thus overestimating the participants' cognitive and disability status 1 month later. CONCLUSION When compared to disability and quality of life measures, it is apparent that the CPC has limited ability to discriminate between mild and moderate brain injury. The validity of using the chart review method for obtaining scores is questionable.
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Affiliation(s)
- Ketki D Raina
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Occupational Therapy, 5012 Forbes Tower, Pittsburgh, PA 15260, USA.
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Stiell IG, Callaway C, Davis D, Terndrup T, Powell J, Cook A, Kudenchuk PJ, Daya M, Kerber R, Idris A, Morrison LJ, Aufderheide T. Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 2: rationale and methodology for "Analyze Later vs. Analyze Early" protocol. Resuscitation 2008; 78:186-95. [PMID: 18487004 DOI: 10.1016/j.resuscitation.2008.01.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 01/18/2008] [Accepted: 01/29/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary objective of the trial is to compare survival to hospital discharge with modified Rankin score (MRS) < or =3 between a strategy that prioritizes a specified period of CPR before rhythm analysis (Analyze Later) versus a strategy of minimal CPR followed by early rhythm analysis (Analyze Early) in patients with out-of-hospital cardiac arrest. METHODS Design-Cluster randomized trial with cluster units defined by geographic region, or monitor/defibrillator machine. Population-Adults treated by emergency medical service (EMS) providers for non-traumatic out-of-hospital cardiac arrest not witnessed by EMS. Setting-EMS systems participating in the Resuscitation Outcomes Consortium and agreeing to cluster randomization to the Analyze Later versus Analyze Early intervention in a crossover fashion. Sample size-Based on a two-sided significance level of 0.05, a maximum of 13,239 evaluable patients will allow statistical power of 0.996 to detect a hypothesized improvement in the probability of survival to discharge with MRS < or =3 rate from 5.41% after Analyze Early to 7.45% after Analyze Later (2.04% absolute increase in primary outcome). CONCLUSION If this trial demonstrates a significant improvement in survival with a strategy of Analyze Later, it is estimated that 4000 premature deaths from cardiac arrest would be averted annually in North America alone.
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Meyer-Zehnder B, Pargger H, Reiter-Theil S. Folgt der Ablauf von Therapiebegrenzungen auf einer Intensivstation einem Muster? ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s00390-007-0813-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yi HJ. Factors Associated with Survival and Neurological Outcome after Cardiopulmonary Resuscitation of Neurosurgical Intensive Care Unit Patients. Neurosurgery 2007. [DOI: 10.1227/01.neu.0000255372.49722.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wijdicks EFM, Rabinstein AA. Factors associated with survival and neurological outcome after cardiopulmonary resuscitation of neurosurgical intensive care unit patients. Neurosurgery 2007; 60:E582; author reply E582. [PMID: 17327773 DOI: 10.1227/01.neu.0000255371.11605.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Reisfield GM, Wallace SK, Munsell MF, Webb FJ, Alvarez ER, Wilson GR. Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: A meta-analysis. Resuscitation 2006; 71:152-60. [PMID: 16987581 DOI: 10.1016/j.resuscitation.2006.02.022] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 02/22/2006] [Accepted: 02/22/2006] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking. OBJECTIVE To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation. METHOD A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge. RESULTS Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%. CONCLUSIONS Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.
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Affiliation(s)
- Gary M Reisfield
- Division of Palliative Medicine, Department of Community Health and Family Medicine, University of Florida Health Science Center - Jacksonville, 655 West Eight Street, Jacksonville, FL 32209, United States.
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Abstract
To review the current management of in-hospital cardiac arrest and to identify variables that influence outcomes, OLDMEDLINE from 1950 to 1966 and MEDLINE from 1966 to March 2005 were searched using the keywords cardiopulmonary resuscitation, cardiac arrest, in hospital, and adult. Secondary sources were derived from review publications and personal communications by one of the authors. There is no secure evidence that the ultimate outcomes after cardiopulmonary resuscitation in settings of in-hospital cardiac arrest have improved in the >40 yrs that followed the landmark report by Kouwenhoven, Jude, and Knickerbocker, which launched the modern era of cardiopulmonary resuscitation. A paucity of objective measurements preclude secure protocols for sequencing of interventions and, even more, when to initiate and discontinue cardiopulmonary resuscitation. The preparedness of both physicians and nursing professionals to implement the published guidelines has itself been questioned. Whereas early access defibrillation with automated external defibrillators may be of benefit in out-of-hospital settings, there has as yet been no secure evidence that automated external defibrillators have had a favorable impact on in-hospital cardiopulmonary resuscitation when used on infrequent occasions by first responders. This contrasts with the much greater success of advanced life support providers and especially when electrical defibrillation is promptly performed by expertly trained personnel after onset of cardiac arrest. Outcomes are therefore improved in critical care settings and especially in coronary care units in which patients are continuously monitored.
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Affiliation(s)
- Max Harry Weil
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA
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