title: Cardiopulmonary resuscitation in critically ill neurologic-neurosurgical patients.
abstract: OBJECTIVE
  To establish the rate of successful cardiopulmonary resuscitation (CPR) and to study outcome predictors in patients who experienced in-hospital cardiac arrest after being admitted to the neurologic-neurosurgical intensive care unit (ICU) with a primary neurologic diagnosis.
  
  
  METHODS
  We identified patients admitted to the neurologic-neurosurgical ICU between 1994 and 2001 who experienced in-hospital cardiac arrest and received CPR. Functional outcome was assessed using the modified Rankin scale.
  
  
  RESULTS
  During the study period, 38 consecutive patients experienced in-hospital cardiac arrest and received CPR. The median age of the patients was 65 years (range, 16-81 years), and the mean interval from admission to CPR was 12 days (range, 3 hours to 47 days). Acute intracranial disease was present in 32 patients (84%). Twenty-one patients (55%) were in the ICU at the time of the cardiac arrest; cardiac arrests in the wards occurred at a mean interval of 9 days (range, 1-45 days) after ICU discharge. Cardiopulmonary resuscitation achieved return of spontaneous circulation in 23 patients (61%). Seven patients (18%) were discharged from the hospital, 5 of whom later achieved a modified Rankin scale score of 2 or lower. Cardiac arrest after a deteriorating clinical course resulted in uniformly fatal outcomes. Duration of CPR shorter than 5 minutes and CPR in the ICU were associated with survival and good functional recovery.
  
  
  CONCLUSIONS
  Cardiopulmonary resuscitation is a worthwhile procedure in severely ill neurologic-neurosurgical patients, regardless of the patient's age. However, the outcome after CPR appears much worse in patients with a prior deteriorating clinical course.
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: Edward M
authors.initials: EM
authors.lastname: Manno
authors.forename: John L D
authors.initials: JL
authors.lastname: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002493:Central Nervous System Diseases / Q000150:complications*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome