Factors influencing survival after in-hospital cardiopulmonary resuscitation

doi:10.1016/j.resuscitation.2005.04.004

Resuscitation

Volume 66, Issue 3, September 2005, Pages 317-321

https://doi.org/10.1016/j.resuscitation.2005.04.004 Get rights and content

Abstract

Introduction:

During recent years, in-hospital cardiopulmonary resuscitation (CPR) management has received much attention. However, the rate of survival after in-hospital resuscitation in Iran hospitals is not known. Therefore, a study was designed to evaluate the outcome of in-hospital cardiopulmonary resuscitation (CPR) in the city of Kashan, Iran, during a 6-month period during 2002.

Material and methods:

A prospective descriptive study was conducted on all cases of in-hospital cardiopulmonary resuscitation. Necessary data including the age and sex of patients, shift, time from cardiac arrest until initiating of CPR, time from cardiac arrest until defibrillation, duration and result of CPR, were recorded in a checklist. Descriptive statistics presented.

Results:

A total of 206 cases of CPR were attempted during the research period. The study population consisted of 59.2% males and 40.8% females. The survival rate was similar for both sexes. Short-term survival was observed in 19.9% of cases and only 5.3% survived to discharge. The key predictors of survival to hospital discharge were CPR duration, time of cardiac arrest, time from cardiac arrest to initiation of CPR, and defibrillation within the first few minutes of cardiac arrest.

Conclusions:

Our study showed that it needs more attention to be paid to cardiopulmonary resuscitation management in Iran's hospitals. The results of this study could be an important first step toward a national study on the survival after cardiopulmonary resuscitation to provide accurate data on our performance with regards to the chain of survival.

Introduction

Cardiopulmonary arrest is an unfortunate incident that can occur unexpectedly at any time or anywhere and has a high mortality [1], [2]. However, many cases could be saved by immediate cardiopulmonary resuscitation (CPR) [3], [4], [5]. It is well recognized that improved outcomes from cardiac arrest are dependant on three key factors: (a) early institution of effective CPR, (b) optimizing response times, and (c) early defibrillation [6], [7], [8].

The chance of success for CPR increases when it is delivered within the first 4 min of arrest and defibrillation within 8 min. The rate of survival declines if either time limit is exceeded [9]. Some authors have reported that the survival rate following out of hospital resuscitation has improved by 30–40% by decreasing response time, early CPR, widespread CPR training, a short distance to the site of arrest, and skill of ACLS teams [9], [10]. Herlitz found that patients with in-hospital cardiac arrest had a survival rate more than four times higher than the out-of-hospital group [11]. However, some other studies have reported that the survival rate after in-hospital CPR is low [6], [7], [12].

In an effort to explain this low rate of success of in-hospital resuscitation, many authors have examined the relation between pre-arrest variables and survival following in-hospital CPR [13], [14], [15]. These studies have reported that hospitalized patients may have a poor prognosis because of critical circulatory, respiratory, neurological, and malignant disorders. Age, hypotension, azotemia, pneumonia and homebound life style were also shown to be independent predictors of mortality after in-hospital CPR [10], [16]. Others have attributed the low survival rate after in-hospital CPR to the factors such as poor knowledge and skill of health care providers, and their lack of formal life support training [2], [4], [10], [17], [18].

Accurate resuscitation rates are necessary for evidence-based end-of-life treatment. However, there is no published work from Iran to confirm or refute these reports. Iranians currently rely on data that is overwhelmingly from the United States and Europe where the outcome of CPR may be affected by different medical practices. For example, in the USA there is better provision of intensive care services for management of patients after cardiac arrest, and there may be a greater knowledge of basic and advanced life support among health care providers.

Considering the difference between reported studies, a variety of influencing factors and lack of information about the success rate of in-hospital CPR in Iran, this study was conducted to determine some peri-arrest variables and survival following in-hospital CPR in hospitals in Kashan, Iran.

Section snippets

Material and methods

A prospective descriptive study was conducted on all patients who received CPR for the first 6 months of the year 2002 in four educational hospitals in Kashan, Iran. Any patient who received in-hospital CPR was included. A checklist was prepared for recording the data in each case. The checklist was made up of 11 questions including: type of ward, age, sex, working shift, underlying cause of cardiac arrest, time served from cardiac arrest to CPR initiation (response time) and to the first

Results

A total number of 206 cases of CPR were attempted during the research period. The study population consisted of 122 males (59.2%) and 84 females (40.8%) ranging in age from 2 to 90 years with a mean age of 53.87 ± 22.3 years.

The rates of success were similar for both sexes. From the total of CPR cases, 74.8% (154 cases) were unsuccessful, 19.9% (41 cases) resulted in short-term survival, and only 5.3% (11 cases) survived to hospital discharge.

Cardiac disease accounted for the underlying aetiology

Discussion

A small number of patients survived after cardiac arrest. The overall rate of survival to hospital discharge was 5.3% for in-hospital CPR. Though the overall survival rates have been low in several studies, our findings contrast with the results from Takeda et al., Marwick et al., Tortolani et al., Kuhnigk et al., Ebell et al., Hayward, and Zoch et al. who reported long-term survival rates of 13.4 to 32.2% [16], [19], [20], [21], [22], [23], [24]. This wide difference could be related to the

Conclusions

Our study was the first analysis of in-hospital CPR in our region. The results of the study demonstrate a low survival rate in comparison with other studies, especially in USA and Europe. The study supports previous findings that to increase survival from in-hospital CPR, the response time should be shortened and the facilities for early defibrillation should be increased. So the need for improvements in CPR management strategies, equipping hospital wards with better facilities for CPR,

Conflict of interest statement

There are none.

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^☆: A Spanish translated version of the Abstract and Keywords of this article appears as an Appendix at 10.1016/j.resuscitation.2005.04.004.

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Factors influencing survival after in-hospital cardiopulmonary resuscitation☆

Abstract

Introduction:

Material and methods:

Results:

Conclusions:

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusions

Conflict of interest statement

Nurse Edu Today

Resuscitation

Chest

Lancet

Resuscitation

Resuscitation

Lancet

Resuscitation

Guidelines for cardiopulmonary resuscitation and emergency cardiac care

JAMA

Evaluation of knowledge and skills of medical personnels of Kashan hospitals regarding cardiopulmonary resuscitation

FEYZ (Journal of Kashan University of Medical Sciences)

Survivors of out of hospital cardiac arrest: Their prognosis, longevity and functional status

Resuscitation

Sudden death from cardiac arrest—improving the odds

N Engl J Med

A study of out-of-hospital cardiac arrest in Northeastern Minnesota

JAMA

One-year survival after out-of-hospital cardiac arrest in Bonn city: Outcome report according to the ‘Utstein style’

Resuscitation

A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome

J Intern Med