Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation
Introduction
Several publications have reported the outcome of cardiopulmonary arrest in hospitalized patients over the past four decades. The majority of these reports are from single institutions, making generalization and meaningful comparisons difficult in the face of nonuniform data elements and definitions. To address this lack of standardization among patient, event, and outcome variables and to provide guidelines for the uniform reporting of hospital-based resuscitation events, in 1997 the International Liaison Committee on Resuscitation developed and published the Utstein style guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation [1]. These guidelines represent an international consensus on the processes that hospitals should use to collect and review data on adult and pediatric in-hospital resuscitations. They also provide a template for capturing all events for which resuscitation might be indicated. This systematic approach is vital to permit valid comparisons among hospitals and to track changes over time, both in single institutions and across the healthcare system as a whole [1], [2], [3], [4].
American Heart Association (AHA) volunteers from the disciplines of cardiology, emergency medicine, pediatric and adult critical care medicine, nursing administration, and nursing education drafted a model for a registry of in-hospital cardiopulmonary resuscitation. This model, which was based on the in-hospital Utstein guidelines, was given to the AHA and has evolved into the National Registry of Cardiopulmonary Resuscitation (NRCPR). Following software development and preliminary beta testing, the registry was launched on January 1, 2000. The NRCPR allows participating hospitals to track the characteristics, treatment, and outcomes of persons who develop cardiac arrest in the hospital. The registry is based on the Utstein in-hospital template.
The purpose of this article is to describe the NRCPR and provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States.
Section snippets
Data collection
The NRCPR is an AHA-sponsored, prospective, multisite, observational study of in-hospital resuscitation. Although the number of hospitals enrolled in the NRCPR changes, this analysis includes medical/surgical hospitals that provided at least 6 months of data from January 1, 2000, through June 30, 2002. Participating hospitals join the NRCPR voluntarily and are charged an annual fee for data support and report generation. Participants are asked to characterize facilities, staff, patients, and
Hospital characteristics
A total of 207 (75 adult, 132 mixed adult and pediatric) hospitals submitted >6 months of in-hospital adult cardiac arrest data during the data collection period of January 21, 2000, through June 30, 2002. Participating hospitals had a median of 260 total beds (46% had <250 beds; 38%, from 250 to 499 beds; and 16%, >500 total beds) and a median of 20 ICU beds, defined by the NRCPR as any unit, including critical care unit and stepdown, with hardwired bedside monitoring (59% had <25 ICU beds;
Discussion
The NRCPR is currently the largest ongoing registry of in-hospital cardiopulmonary resuscitation. In its first 2 years, the number of cases in the registry dwarfed the number of cases previously reported by single institutions [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35] and groups of hospitals [36]. The closest counterpart of the NRCPR was the
Conclusions
The NRCPR is currently the largest multi-institutional, standardized database of in-hospital resuscitation events. It provides data on CPR process and outcome, allowing participants to evaluate their resuscitation performance critically in comparison with other institutions and to track secular trends over time. The registry provides important observational data that can be used by the AHA and other organizations to improve the base of evidence for future resuscitation guidelines and provide
Acknowledgements
The authors wish to thank the AHA, Dr Jerry Potts, Mr Michael C. Bell, and Mr Ted S. Borek, Jr., for their unwavering support in the development of the NRCPR; Tri-Analytics, Inc, especially Mr Scott Carey and Mr Ted Bemb, for providing technical and statistical management of the registry and data; and all participating NRCPR hospitals for helping to improve the process and outcomes of resuscitation in the hospital.
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