Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of "limited" resuscitations

Background: The results of in-hospital resuscitations may depend on a varie ty of factors related to the patient, the environment, and the extent of re suscitation efforts. We studied these factors in a large tertiary referral hospital with a dedicated certified resuscitation team responding to all ca rdiac arrests. Methods: Statistical analysis of 445 prospectively recorded resuscitation r ecords of patients who experienced cardiac arrest and received advanced car diac life support resuscitation. We also report the outcomes of an addition al 37 patients who received limited resuscitation efforts because of advanc e directives prohibiting tracheal intubation, chest compressions, or both. Main Outcome Measures: Survival immediately after resuscitation, at 24 hour s, at 48 hours, and until hospital discharge. Results: Overall, 104 (23%) of 445 patients who received full advanced card iac life support survived to hospital discharge. Survival was highest for p atients with primary cardiac disease (30%), followed by those with infectio us diseases (15%), with only 8% of patients with end-stage diseases survivi ng to hospital discharge. Neither sex nor age affected survival. Longer res uscitations, increased epinephrine and atropine administration, multiple de fibrillations, and multiple arrhythmias were all associated with poor survi val. Patients who experienced arrests on a nursing unit or intensive care u nit had better survival rates than those in other hospital locations. Survi val for witnessed arrests (25%) was significantly better than for nonwitnes sed arrests (7%) (P=.005). There was a disproportionately high incidence of nonwitnessed arrests during the night (12 AM to 6 AM) in unmonitored beds, resulting in uniformly poor survival to hospital discharge (0%). None of t he patients whose advance directives limited resuscitation survived. Conclusions: Very ill patients in unmonitored beds are at increased risk fo r a nonwitnessed cardiac arrest and poor resuscitation outcome during the n ight. Closer vigilance of these patients at night is warranted. The outcome of limited resuscitation efforts is very poor.