A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital

Objectives: To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated wit h survival to the time of hospital discharge. Design: A 2-year prospective cohort study. Setting: Foothills Medical Centre, a 700-bed tertiary, academic and regiona l referral centre for Calgary and southern Alberta. Patients: Adult inpatients, excluding those who had cardiac arrest in the E mergency Department or operating room. Intervention: Cardiac resuscitation. Main outcome measures: Spontaneous return of the pulse with a minimum systo lic blood pressure of 80 mm Hg and survival defined as survival to the time of hospital discharge. Results: In 334 patients there were 390 cardiac arrests, of which 200 were primary cardiac arrests and 39 cardiac arrests that occurred while the resu scitation team was in attendance. Of 239 resuscitated patients, 51 (21.3%) survived. Fifteen variables were identified as being associated with surviv al. This association could be explained, through multivariate analysis, by the effect of the following 3 variables (odds ratio [OR], 95% confidence in terval [CI]): initial observed rhythm other than pulseless electrical activ ity or asystole (OR 17.34, 95% CI 8.2 to 36.8); a patient who was ambulator y and able to provide self-care (OR 3.8, 95% CI 1.9 to 7.5); and a spontane ous return of circulation with resuscitation in less than 20 minutes (OR 12 .9, 95% CI 4.8 to 20.7). Conclusions: Survival to hospital discharge after cardiac arrest remains st atic. Initial cardiac rhythm and duration of resuscitation before spontaneo us return of circulation were the most important risk factors for survival. These factors and the patient's functional status are relevant when discus sing cardiac resuscitation with patients or when considering whether to dis continue resuscitation efforts.