PREDICTORS OF SURVIVAL FOLLOWING IN-HOSPITAL CARDIOPULMONARY RESUSCITATION - A MOVING TARGET

Background: Counseling patients about the risks and benefits of in-hos pital cardiopulmonary resuscitation (CPR) can potentially reduce patie nt suffering and hospital costs. However, there is currently much disa greement regarding the overall rate of in-hospital CPR survival and ch aracteristics that identify patients more or less likely to survive CP R. Methods: The charts of all adults who were pulseless and received b asic CPR at a 720-bed university hospital during 1990 and 1991 were re viewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room , or cardiac catheterization laboratory. Each patient's chart was revi ewed to determine the presence of explicitly defined clinical characte ristics. Results: Overall, 50 (16.0%) of 313 patients survived to disc harge. Before arrest, only impaired functional capacity and sepsis ide ntified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0 % of those with cancer and 18.1% of those 70 years or older. Conclusio ns: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate rep orted here is higher than similar reports and why more clinical charac teristics were not found to predict CPR survival. Investigators of in- hospital CPR should use explicit criteria to describe the conditions s tudied and report survival for patients who receive basic CPR. The imp act of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.