Records of inhospital cardiopulmonary resuscitation in a medical cardiologic ICU

Introduction

New techniques have been used in cardiopulmonary resuscitation (CPR) since the introduction of closed cardiac massage in 1960. Despite this progress, there was no significant improvement in survival rates after inhospital cardiac arrest over the past 40 years. In a general hospital, survival rates at discharge, not considering specifically ICU patients, is around 15–20%. Few data are available considering survival in cardiologic critical care units.

Methods

Between April 2004 and December 2004 we recorded and analysed all attempted cardiopulmonary resuscitation in a medical ICU of a teaching cardiologic hospital. The patients were 64 ± 20 years. Forty-four (62.8%) were male and 26 (37.2%) were female. Diagnosis at admission to the ICU were: cardiogenic and/or septic shock, 37.2%; heart failure (NYHA IV), 20%; acute coronary syndrome, 21.4%; acute respiratory failure, 10%; others, 11.4%. Associated diseases: acute renal failure, 68.5%; hypertension, 60%; diabetes mellitus, 37.2%; COPD, 10%; infection, 91.5%. Using an Utstein-based template, data were collected immediately after each resuscitation, by physicians who have performed CPR. They were previously certified in Advanced Cardiac Life Support.

Results

Seventy cardiopulmonary arrests were recorded in 50 patients. Of these, 49% returned to spontaneous circulation and 4% had hospital discharge. Twelve patients had more than one event. The first pulse rhythm was divided as follows: VF/VT (14.08%), asystole (19.7%), PEA (66.22%). Predictive factors of return to spontaneous circulation in univariate analysis were: time from ICU admission to cardiopulmonary arrest ≤ 7 days (P = 0.03), age <75 years (P = 0.003), time of CPR <18 min (P = 0.0001). In multivariate analysis, only the time from admission to the ICU to cardiopulmonary arrest ≤ 7 days was predictive of return to spontaneous circulation (P = 0.015, odds ratio 1.19, 95% CI 0.6–5.9).

Conclusion

Survival after CPR in cardiac patients is poor. Considering our population, it is lower than that observed in general hospital patients. These data could help physicians in attempting resuscitation, and patients and families in making end-of-life decisions.