Outcomes and Cost Analysis of Patients With Successful In-Hospital Cardiopulmonary Resuscitation

Abstract

This study evaluated the outcomes of patients after in-hospital cardiac arrest who were admitted to the intensive care unit (ICU) with successful cardiopulmonary resuscitation (CPR). Data were extracted from a prospectively maintained database of intubation and mechanical ventilation in a tertiary hospital. Adult patients (age ≥ 18 years) with successful CPR and admitted to the ICU were included for analysis. The characteristics of the patients and the outcomes were analyzed. A total of 313 patients were included from January 1, 2004, to December 31, 2004, with 114 (36.4%) admitted from the emergency department and 199 (63.6%) from the ward. The in-hospital mortality was high (209, 66.8%), with 130 (62.2%) of the patients dying within 24 hours. The nonsurvivors had a significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Therapeutic Intervention Scoring System (TISS) score but a lower Glasgow Coma Scale (GCS), a shorter ICU and hospital stay, shorter mechanical ventilation (MV) hours, and fewer expenses. Patients with early mortality (< 24 hours) had a significantly higher APACHE II score and a greater portion were admitted from the ward. Only 73 (23.3%) were discharged home and 31 (9.9%) were transferred to a chronic care center. Patients who were discharged to chronic care centers were older, had a higher APACHE II score, higher medical expenses, more MV hours, longer ICU and hospital stays, but a lower GCS than those who were discharged home. The mean expense for survivors was about threefold that of nonsurvivors, and patients who were discharged to a chronic care center had the highest mean hospital expense, which was about sixfold of the patients with early mortality. Although survivors comprised 33.3% of the in-hospital cardiac arrest patients with return of spontaneous circulation, they have consumed 60% of the total hospital expenses. Given the fact that less than one quarter of the successfully resuscitated patients have a favorable outcome, two-thirds of the mortality cases died within 24 hours, which is a high cost for successful resuscitation, and one-third of the survivors had to stay on chronic respiratory care center. A better prognostic tool to predict outcomes should be developed to avoid futile resuscitation.