Clinical Antecedents to Cardiopulmonary Resuscitation in the Medical Intensive Care Unit: A Retrospective Study

Abstract

Background: The clinical antecedents of cardiopulmonary arrest in the intensive care unit have not been well defined yet. Methods: We retrospectively reviewed those patients who received cardiopulmonary resuscitation in the medical intensive care unit over a 2-year period. We evaluated a number of pre-arrest conditions to determine if the outcome after cardiopulmonary resuscitation was influenced by any of these parameters. Results: A total of 45 patients (1.2% of medical intensive care unit admissions) were identified. Among them, 27 (60%) were successfully resuscitated with recovery of spontaneous circulation, but only 4 patients (8.9%) survived to hospital discharge. A total of 38 (84%) and 17 (38%) of the patients had documented observations of clinical deterioration within 8 and 24 hours of arrest, respectively. Patients developing arrest in the medical intensive care unit have predominantly respiratory and cardiovascular derangements in the underlying disease. Arrest was frequently preceded by a clinical deterioration involving hypotension. Antecedent cardiovascular events (RR=0.182, p=0.018), including shock, and expected arrests (RR=0.125, p=0.009), were associated with a worse chance of recovery of spontaneous circulation. Conclusion: Patients receiving cardiopulmonary resuscitation have a poor outcome. Expected arrests and antecedent cardiovascular events are associated with a reduced chance of successful resuscitation.