Survival after Cardiopulmonary Resuscitation in the Hospital

Bedell SE, Delbanco TL, Cook EF, Epstein FH New England Journal of Medicine 1983 Vol 309 Pages 569-576

In contrast to out-of-hospital arrest, a subject that has received extensive study, little is known about prognostic factors that determine outcomes after in-hospital cardiopulmonary resuscitation. The authors studied 294 consecutive patients prospectively who were resuscitated in a university teaching hospital. The patients consisted of 160 men and 134 women with a mean age of 70 years (range 18-101 years). The most common clinical diagnosis was coronary-artery disease. Before cardiac arrest, 41% had an acute myocardial infarction in the hospital, 73% had a history of congestive heart failure, and fully 20% had a history of prior cardiac arrest and resuscitation. Thirty patients had subsequent arrests. After the initial resuscitation, pulse and blood pressure were restored in 128/294 (44%) and 166 (56%) died. 31/128 died within 24 hours of resuscitation, and another 56 died before leaving hospital. Forty-one patients (14%) were discharged from the hospital; 33/41 (80%) were still alive six months later. The patients who were successfully resuscitated within 15 minutes of the arrest, were alert, and did not require pressors 24 hours after resuscitaiton had a survival rate of 92%. In contrast, patients whose arrest lasted longer than 15 minutes, who were comatose, or who required pressors had a survival rate of only 18% (P<0.0001). A multivariate analysis revealed that pneumonia, hypotension, renal failure, cancer, and a homebound life style before hospitalization were significantly associated with in-hospital mortality (P<0.05). None of the 58 patients with pneumonia and none of the 179 in whom resuscitation took longer than 30 minutes survived to discharge. Fully 42% of the patients who survived for 24 hours after resuscitation left the hospital. At time of discharge and again 6 months later, 93% of the survivors were mentally intact. Depression was generally present at discharge but subsequently resolved. Age alone did not appear to influence the prognosis for survival after cardiopulmonary resuscitation. The authors feel their findings require validation in a larger sample and in a variety of settings. At the very least however, they may serve as a helpful guide to physicians and to patients and their families who are concerned about the likelihood of a successful outcome after resuscitation.