In-hospital Resuscitation Research Articles

In-hospital cardiopulmonary resuscitation: patient, arrest and resuscitation factors associated with survival

Data on 470 adults with single in-hospital cardiac arrest resuscitations were analyzed to determine 24-h and discharge survival rates and to identify significant correlates of survival. One hundred fifty-three (33%) patients were alive 24 h after initiation of cardiopulmonary resuscitation; 69 (45% of 24-h survivors, 15% of all patients) were discharged alive. Logit analysis identified the following independently significant correlates of 24-h survival: arrest locations other than emergency room or cardiac care unit, CPR duration less than 15 min, non-cardiac primary diagnosis, non-asystolic dysrhythmia, less than one intravenous and one drip-administered inotrope and absence of pacemaker insertion and defibrillation. Fifty-one (94%) of 54 patients with all of these characteristics were alive 24 h after initiation of CPR. The same variables, as well as age less than 68 years and absence of intubation were statistically associated with discharge survival. Nine (64%) of 14 patients with all of these characteristics were discharged alive. Increased intervention was generally associated with increased mortality. Overall survival rates replicate previous reports and may reflect the effects of diagnosis-related groups policies on the average illness severity of the in-patient population, rather than failure of current CPR methods to improve the probability of survival. Use of the data as baseline for future studies and as a source of hypotheses for research on decision making are discussed.

Effect of hypothermia and cardiac arrest on outcome of near-drowning accidents in children

We conducted a retrospective review of 55 near-drowning victims (mean age 4.75 years) admitted to the intensive care unit during a 5-year period, to determine the factors that may influence survival both before and after hospital admission. All patients who remained comatose after resuscitation received ventilation for an initial 24 hour period, after which an assessment of central nervous system injury was made. Intracranial pressure was not monitored, and barbiturate therapy was used only for seizure control. Thirty-seven children survived and 18 died; five survivors had profound neurologic damage resulting in a persistent vegetative state: the remaining 32 (58%) survived intact. The major factors that separated intact survivors from those who died and from survivors in a persistent vegetative state were the presence of a detectable heartbeat and hypothermia (less than 33 degrees C) on examination in the emergency department. Thirteen patients with absent vital signs and a temperature of greater than 33 degrees C either died or survived in a persistent vegetative state. Fourteen patients had a combination of absent vital signs and hypothermia and were resuscitated; eight died, two survived in a persistent vegetative state, and four survived intact. All intact survivors had been submerged in cold water for prolonged periods, and all underwent prolonged cardiopulmonary resuscitation. All patients with a detectable pulse, regardless of temperature, survived without neurologic sequelae. The 58% intact survival rate in this series compares favorably with the 50% we reported previously when high-dose barbiturate therapy and hypothermia were used to control intracranial pressure; at the same time, the number of survivors with a persistent vegetative state has been reduced by 50%. We conclude that prolonged in-hospital resuscitation and aggressive treatment of near-drowning victims who initially have absence of vital signs and are not hypothermic either results in eventual death or increases the number of survivors with a persistent vegetative state.

Effect of New York state's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice

purpose: On April 1, 1988, New York State enacted legislation governing the withholding of cardiopulmonary resuscitation (CPR). Suggestions that the mandated protocol for withholding CPR is too cumbersome and will result in an increase in CPR attempts led us to study the effect of the new law on in-hospital resuscitation practice. patients and methods: We retrospectively reviewed the charts of 245 adult in-patients at a county teaching hospital who died during three-month periods before and after the law took effect. results: There was a statistically nonsignificant decline in the frequency of CPR attempts at the time of death, from 59 (50%) of 119 patients in 1987 to 57 (45%) of 126 patients in 1988. Use of explicit written “do-not-resuscitate” (DNR) orders increased significantly from 13 (22%) of 60 patients who died without CPR in 1987 to 64 (93%) of 69 patients in 1988. Patient and family involvement in decisions to withhold CPR was common before the law and did not change significantly. conclusion: Although changing the way DNR decisions are documented, the legislation resulted in no significant change either in the frequency of CPR or in the degree to which patients are involved in these decisions.

Resuscitation of hospitalized patients

Effects of in-hospital resuscitations performed by a trained resuscitation team were studied over a 20-month period during which 1653 deaths were registered. Resuscitative attempts were made in 61 patients with a mean age of 71 years (range 0-86 years). The underlying disease was ischaemic heart disease in 38 cases and most arrests occurred in general wards. Twenty-one patients were initially resuscitated; 12, however, died after an average of 3.2 days while still in hospital. Nine patients were discharged and seven are still alive after two and a half years.

Intravenous amiodarone during prolonged resuscitation from cardiac arrest.

Brief Reports15 May 1989Intravenous Amiodarone during Prolonged Resuscitation from Cardiac ArrestMarcus L. Williams, MD, Alan Woelfel, MD, Wayne E. Cascio, MD, Ross J. Simpson Jr., MD, Leonard S. Gettes, MD, James R. Foster, MDMarcus L. Williams, MDSearch for more papers by this author, Alan Woelfel, MDSearch for more papers by this author, Wayne E. Cascio, MDSearch for more papers by this author, Ross J. Simpson Jr., MDSearch for more papers by this author, Leonard S. Gettes, MDSearch for more papers by this author, James R. Foster, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-10-839 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBecause only 13% of patients with in-hospital cardiac arrest survive to discharge from the hospital (1, 2), with none surviving when resuscitation exceeds 30 minutes (1), there is an urgent need for more effective means of treating hospitalized patients with cardiac arrest. Intravenous amiodarone may produce rapid control of frequently recurring ventricular tachycardia when given outside the setting of cardiac arrest (3-7). Therefore, we administered amiodarone intravenously to 14 patients during prolonged in-hospital resuscitation from refractory cardiac arrest due to ventricular tachycardia or ventricular fibrillation from October 1982 through February 1988. Clinical details, obtained from review of hospital records, are...

In-Hospital Cardiopulmonary Resuscitation

To the Editor. — We read with interest the report by Taffet and collegues 1 concerning their experience with in-hospital cardiopulmonary resuscitation at the Houston (Tex) Veterans Administration Medical Center. Review of the literature and our own experience lead us to believe, as the authors suggest, that their results are not representative of those in many acute-care hospitals. They reported a 6.7% survival for all patients (preponderantly male) and a 0% survival to hospital discharge in patients 70 years of age or older. A 2-year experience (January 1, 1986, to December 31, 1987) with in-hospital resuscitation in our 590-bed community hospital is more favorable, as shown in Table 2. Our overall survival rate was 15.5%: 24.5% for patients younger than age 70 years and 12.7% for patients aged 70 years and older. Of the groups represented in Table 2, survival rate was lowest for men aged 70 years and older, but

In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: ‘Heroic Efforts’ or an exercise in futility?

From our emergency department logbook we identified 281 consecutive patients transported to the Regional Medical Center at Memphis following failed prehospital advanced cardiac life support (ACLS). Medical records were obtained for 240 cases (85.4%). Initial cardiac rhythms in the ED included ventricular fibrillation or pulseless ventricular tachycardia (29%), electromechanical dissociation (18%), and asystole (51%). Thirty-two patients (13.3%) were successfully resuscitated in the ED, but only four (1.7%) survived to hospital discharge. Two patients had good neurologic outcomes; both degenerated to cardiac arrest shortly prior to arrival in the ED. The remaining two survivors were discharged to nursing homes with severe neurologic deficits. Of the 41 cases for whom no medical records could be found, 39 were noted in our logbook to have died in the ED. No record of subsequent hospital admission could be found for the other two. Both are presumed to have died. Failure to respond to prehospital ACLS predicts nonsurvival and may warrant cessation of efforts in the field. Future programs and research efforts in the management of out-of-hospital cardiac arrest should be focused on optimal provision of prehospital care prior to the onset of irreversible deterioration.

Fatal envenomation by Chironex fleckeri , the north Australian box jellyfish: the continuing search for lethal mechanisms

A child with severe envenomation by Chironex fleckeri presented in cardiac arrest at a hospital between 15 and 20 min after the sting was sustained. Resuscitation was not successful. Objective confirmation of C. fleckeri as the cause of death is described. Four metres of tentacle contact in this case represents the smallest-measured fatal C. fleckeri sting that has been recorded so far. The mechanism of this death was toxic and not allergic. The available clinical information suggests direct myocardial interference, but does not exclude a respiratory hypoxic element. A more widespread venom-induced functional disruption of the cell membrane is postulated, with a resultant dysfunction in several vital organ systems that were acting in concert. Early, vigorous and sustained resuscitation that is performed as a first-aid measure offers the best hope of prehospital survival after a massive C. fleckeri sting, which is the most explosive envenomation process that is presently known to humans. In-hospital resuscitation from unresponsive circulatory arrest should now involve intravenously-administered verapamil (or its equivalent) and additional box-jellyfish antivenom, while the patient is being monitored.

In-hospital resuscitation : Sillivan M. J. J. and Guyatt G. H. (1986) Simulated cardiac arrests for monitoring quality of in-hospital resuscitation. Lancet, ii, 618

In-hospital resuscitation : Sillivan M. J. J. and Guyatt G. H. (1986) Simulated cardiac arrests for monitoring quality of in-hospital resuscitation. Lancet, ii, 618

A progress report on the trauma score in predicting a fatal outcome.

Advances in prehospital care have increased the number of trauma patients arriving in extremis in the emergency room. In-hospital resuscitation focuses on an aggressive team approach, raising the specter that some patients who have little chance of survival may receive protracted, but futile, resuscitation efforts. This study examined the physiologic severity on admission and associated costs for resuscitation efforts of severely injured trauma patients who died within 48 hours post admission. The data suggest that a Trauma Score less than or equal to 3 is valuable in identifying patients for whom prolonged resuscitation is futile. The decision to discontinue resuscitation, however, must include consideration of other relevant clinical data.