in-hospital cardiopulmonary resuscitation (CPR)
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Epidemiology
- figures for adults > 65 years of age
- incidence: 2.73 events per 1000 admissions
- survival to hospital discharge is 22%[7][8]; 12.5%[11]
- neurologic deficits among survivors is 28%[7][8]
- long-term survival rates (2000-2008)
- 59% at 1 year, 50% at 2 years, & 44% at 3 years
- 1/2 of patients with mild or no neurological disability
- survival lower among older vs younger patients, among men vs women & among blacks vs whites[3]
- hospital deaths preceded by CPR = 5.2%
- CPR survivors discharged home = 40% (distinguished from discharge to nursing home or hospice)
- blacks were consistently more likely than whites to receive in-hospital CPR & to receive CPR prior to death & were less likely to survive to discharge after CPR
- ref[7] &[10] uses a GO-FAR scoring system that assigns a likelihood of good outcome ranging from < 1% to > 15%[7][10]
- survival rate was lower among patients who were
- men
- older
- had more coexisting illnesses
- admitted from a skilled-nursing facility[1]
Management
- endotracheal intubation during in-hospital cardiopulmonary resuscitation reduces survival to discharge (16 vs 19%)[9]
- predication model for prognosis uses (points)[4]
- age (60-69 1, 70-70 2, >= 80 4)
- initial rhythm & time to defibrillation
- pre-arrest cerebral performance category
- up to 9 points
- location in hospital (telemetry, ICU, ward)
- ward 3 points, ICU point
- duration of resuscitation
- 5-9 minutes 3 points, >= 15 minutes 6 points
- other factors
- renal insufficiency (2 points)
- hepatic insufficiency (4 points)
- sepsis (3 points)
- malignancy (5 points)
- hypotension (4 points)
More general terms
References
- ↑ 1.0 1.1 Ehlenbach WJ et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009 Jul 2; 361:22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19571280
- ↑ Chan PS et al Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009 Sep 16;302(11):1195-201. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19755698
- ↑ 3.0 3.1 Chan PS et al. Long-term outcomes of elderly survivors of in-hospital cardiac arrest. N Engl J Med 2013 Mar 14; 368:1019. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23484828
- ↑ 4.0 4.1 Girotra S, Nallamothu BK, Chan PS. Using risk prediction tools in survivors of in-hospital cardiac arrest. Curr Cardiol Rep. 2014 Mar;16(3):457. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24464303 <Internet> http://download.springer.com/static/pdf/941/art%253A10.1007%252Fs11886-013-0457-0.pdf?auth66=1415384443_59d818f3c66402eabab42746dd073419&ext=.pdf
- ↑ Ebell MH, Jang W, Shen Y, Geocadin RG; Get With the Guidelines-Resuscitation Investigators. Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med. 2013 Nov 11;173(20):1872-1878. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24018585
- ↑ Ramenofsky DH, Weissman DE. #179 CPR Survival in the Hospital setting. EPERC Fast Facts and Concepts #179. Medical College of Wisconsin http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_179.htm
- ↑ 7.0 7.1 7.2 7.3 7.4 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 8.0 8.1 8.2 Girotra S, Nallamothu BK, Spertus JA et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012 Nov 15;367(20):1912-20. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23150959 Free PMC Article
- ↑ 9.0 9.1 Andersen LW et al. Association between tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA 2017 Feb 7; 317:494. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28118660
Angus DC. Whether to intubate during cardiopulmonary resuscitation: Conventional wisdom vs big data. JAMA 2017 Feb 7; 317:477 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28118658 - ↑ 10.0 10.1 10.2 Anderson WG, Chase R, Pantilat SZ, Tulsky JA, Auerbach AD. Code status discussions between attending hospitalist physicians and medical patients at hospital admission. J Gen Intern Med. 2011 Apr;26(4):359-66 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21104036 Free PMC Article
- ↑ 11.0 11.1 Girotra S et al. Survival after in-hospital cardiac arrest in critically ill patients: Implications for COVID-19 outbreak? Circ Cardiovasc Circ Cardiovasc Qual Outcomes. 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32438836 https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006837
Girotra S, et al. Survival After In-Hospital Cardiac Arrest In Critically Ill Patients: Implications For The Covid-19 Pandemic? medRxiv. 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32511438 Free PMC article.