Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff.
OBJECTIVE
To identify a series of variables which predict death after in-hospital cardiopulmonary resuscitation (CPR).


METHODS
Retrospective observational study.


METHODS
A nonteaching community hospital with 24-hr on-site critical care specialists.


METHODS
Consecutive adults undergoing CPR between August 1989 and July 1991.


METHODS
None.


RESULTS
Two hundred forty-two patients suffered a total of 289 cardiopulmonary arrests. Forty patients (16.5%) survived to discharge. Thirty-nine (16%) patients had more than one cardiopulmonary arrest. Survival of second CPR was 18%. Acute physiology and chronic health evaluation (APACHE) II scores within 24 h of admission and CPR (APACHE[a] and APACHE[b]) were measured. APACHE(a) and (b) scores more than 20 had a 96% predictive value positive and were associated with a five-fold decrease in survival. Besides APACHE, cardiopulmonary arrests on medical floors and after day 4 of hospitalization, duration of CPR more than 15 min, and asystole assumed significance at multivariate levels for predicting death. Ventilatory assistance and Glasgow coma score of less than 9 at 24 h after CPR predicted death for initial survivors at multivariate levels. Survival on telemetry units were similar to the ICU (17 vs 21%) but twice that of the medical floors.


CONCLUSIONS
The CPR outcome can be predicted early during hospital course, which may assist physicians to formulate a do-not-resuscitate order. Patients surviving a CPR should be considered candidates for another resuscitation if clinically warranted. Low-risk patients can safely be admitted to telemetry units instead of to more costly ICUs.
Bialecki
L
L
Department of Critical Care Medicine, Christian Hospital Northeast-Northwest, St. Louis, MO 63136, USA.
Woodward
R S
RS
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome