Validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations

Context Most patients undergoing in-hospital cardiac resuscitation do not s urvive to hospital discharge. In a previous study, we developed a clinical decision aid for identifying all patients undergoing resuscitation who surv ived to hospital discharge. Objective To validate our previously derived clinical decision aid. Design, Setting, and Participants Data from a large registry of in-hospital resuscitations at a community teaching hospital in Georgia were analyzed t o determine whether patients would be predicted to survive to hospital disc harge (ie, whether their arrest was witnessed or their initial cardiac rhyt hm was either ventricular tachycardia or ventricular fibrillation or they r egained a pulse during the first 10 minutes of chest compressions). Data fr om 2181 in-hospital cardiac resuscitation attempts in 1987-1996 involving 1 884 pulseless patients were analyzed. Main Outcome Measure Comparison of predictions based on the decision aid wi th whether patients were actually discharged alive from the hospital. Results For 327 resuscitations (15.0%), the patient survived to hospital di scharge, For 324 of these resuscitations, the patients were predicted to su rvive to hospital discharge (sensitivity=99.1%, 95% confidence interval, 97 .1%-99.8%). In 269 resuscitations, patients did not satisfy the decision ai d and were predicted to have no chance of being discharged from the hospita l. Only 3 of these patients (1.1%) were discharged from the hospital (negat ive predictive value=98.9%), none of whom were able to live independently f ollowing discharge from the hospital. Conclusion This decision aid can be used to help physicians identify patien ts who are extremely unlikely to benefit from continued resuscitative effor ts.