Predicting survival from in-hospital CPR: meta-analysis and validation of a prediction model.
OBJECTIVE
To better clarify patient factors that predict survival from in-hospital cardiopulmonary resuscitation (CPR), using two methods: 1) meta-analysis and 2) validation of a prediction model, the pre-arrest morbidity (PAM) index.


METHODS
Meta-analysis of previously published studies by standard techniques. Retrospective chart review of validation sample.


METHODS
University-affiliated teaching hospital.


METHODS
Meta-analytic sample of 21 previous studies from 1965-1989. The validation sample consisted of all patients surviving resuscitation from the authors' hospital during the period September 1986 to January 1991. A matched sample of patients who did not survive from the same time period was used as the comparison group.


METHODS
None.


RESULTS
The strongest negative predictors of survival, by meta-analysis, were renal failure (r = 0.088, p < 0.0002), cancer (r = 0.08, p < 0.0002), and age more than 60 years (r = 0.063, p < 0.006). Sepsis (r = 0.046, p < 0.02), recent cerebrovascular accident (CVA) (r = 0.038, p < 0.04), and congestive heart failure (CHF) class III/IV (r = 0.036, p < 0.05) were weaker negative predictors. Presence of acute myocardial infarction (AMI) was a significant positive predictor of survival (r = 0.15, p < 0.0001). The PAM score was highly predictive of survival in a logistic regression model (p < 0.0003, R2 = 9.6%). No patient who survived to discharge had a PAM score higher than 8.


CONCLUSIONS
Meta-analysis reveals that the most significant negative predictors of survival from CPR are renal failure, cancer, and age more than 60 years, while AMI is a significant positive predictor. The PAM index is a useful method of stratifying probability of survival from CPR, especially for those patients with high PAM scores, who have essentially no chance of survival.
Cohn
E B
EB
Division of General Internal Medicine, Northwestern University Medical School, Chicago, IL 60611.
Lefevre
F
F
Yarnold
P R
PR
Arron
M J
MJ
Martin
G J
GJ
D000367:Age Factors; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002641:Chicago; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate