title: Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of "limited" resuscitations.
abstract: BACKGROUND
  The results of in-hospital resuscitations may depend on a variety of factors related to the patient, the environment, and the extent of resuscitation efforts. We studied these factors in a large tertiary referral hospital with a dedicated certified resuscitation team responding to all cardiac arrests.
  
  
  METHODS
  Statistical analysis of 445 prospectively recorded resuscitation records of patients who experienced cardiac arrest and received advanced cardiac life support resuscitation. We also report the outcomes of an additional 37 patients who received limited resuscitation efforts because of advance directives prohibiting tracheal intubation, chest compressions, or both.
  
  
  METHODS
  Survival immediately after resuscitation, at 24 hours, at 48 hours, and until hospital discharge.
  
  
  RESULTS
  Overall, 104 (23%) of 445 patients who received full advanced cardiac life support survived to hospital discharge. Survival was highest for patients with primary cardiac disease (30%), followed by those with infectious diseases (15%), with only 8% of patients with end-stage diseases surviving to hospital discharge. Neither sex nor age affected survival. Longer resuscitations, increased epinephrine and atropine administration, multiple defibrillations, and multiple arrhythmias were all associated with poor survival. Patients who experienced arrests on a nursing unit or intensive care unit had better survival rates than those in other hospital locations. Survival for witnessed arrests (25%) was significantly better than for nonwitnessed arrests (7%) (P =.005). There was a disproportionately high incidence of nonwitnessed arrests during the night (12 AM to 6 AM) in unmonitored beds, resulting in uniformly poor survival to hospital discharge (0%). None of the patients whose advance directives limited resuscitation survived.
  
  
  CONCLUSIONS
  Very ill patients in unmonitored beds are at increased risk for a nonwitnessed cardiac arrest and poor resuscitation outcome during the night. Closer vigilance of these patients at night is warranted. The outcome of limited resuscitation efforts is very poor.
authors.affiliation: Anesthesiology Service, Baltimore Veterans Affairs Medical Center, 13004 Gent Rd, Reisterstown, MD 21136-5717, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Dumot
authors.forename: D J
authors.initials: DJ
authors.lastname: Burval
authors.forename: J
authors.initials: J
authors.lastname: Sprung
authors.forename: J H
authors.initials: JH
authors.lastname: Waters
authors.forename: B
authors.initials: B
authors.lastname: Mraovic
authors.forename: M T
authors.initials: MT
authors.lastname: Karafa
authors.forename: E J
authors.initials: EJ
authors.lastname: Mascha
authors.forename: D L
authors.initials: DL
authors.lastname: Bourke
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D011446:Prospective Studies; D016414:Resuscitation Orders; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome