Survival after in-hospital cardiopulmonary resuscitation - A meta-analysis

OBJECTIVE: To determine the rates of immediate survival and survival to dis charge for adult patients undergoing in-hospital cardiopulmonary resuscitat ion, and to identify demographic and clinical variables associated with the se outcomes. MEASUREMENTS AND MAIN RESULTS: The MEDLARS database of the National Library of Medicine was searched. In addition, the authors' extensive personal fil es and the bibliography of each identified study were searched for further studies. Two sets of inclusion criteria were used, minimal (any study of ad ults undergoing in-hospital cardiopulmonary resuscitation) and strict (incl uded only patients from general ward and intensive care units, and adequate ly defined cardiopulmonary arrest and resuscitation). Each study was indepe ndently reviewed and abstracted in a nonblinded fashion by two reviewers. T he data abstracted were compared, and any discrepancies were resolved by co nsensus discussion. For the subset of studies meeting the strict criteria, the overall rate of immediate survival was 40.7% and the rate of survival t o discharge was 13.4%. The following variables were associated with failure to survive to discharge: sepsis on the day prior to resuscitation (odds ra tio [OR] 31.3: 95% confidence interval [CI] 1.9, 515), metastatic cancer (O R 3.9; 95% CI 1.2, 12.6), dementia (OR 3.1; 95% CI 1.1, 8.8), African-Ameri can race (OR 2.8; 95% CI 1.4, 5.6), serum creatinine level at a cutpoint of 1.5 mg/dL (OR 2.2; 95% CI 1.2, 3.8), cancer (OR 1.9; 95% CI 1.2, 3.0), cor onary artery disease (OR 0.55; 95% CI 0.4, 0.8), and location of resuscitat ion in the intensive care Mit (OR 0.51; 95% CI 0.4, 0.8). CONCLUSIONS:When talking with patients, physicians can describe the overall likelihood of surviving discharge as 1 in 8 for patients who undergo cardi opulmonary resuscitation and 1 in 3 for patients who survive cardiopulmonar y resuscitation.