Outcomes After Cardiopulmonary Resuscitation in Intensive Care Units

Critically ill patients, especially those requiring hemodynamic support, are unlikely to survive cardiopulmonary arrests.

Using national registry data from >400 intensive care units (ICUs), researchers examined outcomes of 49,656 adults (median age, 69) who suffered first cardiopulmonary arrests (CPAs) while in the ICU between 2000 and 2008. Overall rate of survival to hospital discharge was 15.9%.

Patients who received pressors before CPA were about half as likely to survive to discharge (9.3% vs. 21.2%) or to be discharged home from the hospital (3.9% vs. 8.5%) as were patients who did not require pressors before CPA. The best outcomes were among patients with CPA owing to ventricular tachycardia or ventricular fibrillation who did not require pressors prior to CPA (40.7% survived to discharge; 17.1% were discharged home with good neurological function). Patients who were least likely to survive suffered CPAs caused by pulseless electrical activity or asystole that occurred while they were receiving pressor therapy (5.9% survived to discharge; 1.7% were discharged home with good neurological function). CPAs that occurred at night or on weekends, patient age 65, patient race other than white, and patient requirement for mechanical ventilation also were associated independently with lower survival.

Comment: Among ICU patients who experience CPAs, about 1 in 6 survives to discharge. In patients who require pressors before CPA occurs, the survival rate falls to 1 in 11, with only 1 in 25 discharged home.

Physicians should use this information to help guide families of critically ill patients as they weigh risks and benefits of CPR.

— Matthew Hoffman, MD, and Neil H. Winawer, MD, SFHM

Dr. Hoffman is a Fellow in Pulmonary and Critical Care Medicine at Emory University School of Medicine in Atlanta, Georgia.

Published in Journal Watch Hospital Medicine September 27, 2010

Citation(s):

Tian J et al. Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 2010 Aug 15; 182:501. (http://dx.doi.org/10.1164/rccm.200910-1639OC)

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Dato' Dr. Ismail Yaacob

Medical Director/Consultant Physician
Kedah Medical Centre