Outcome of cardiopulmonary resuscitation in the ICU in a university hospital

Introduction

Cardiac arrest is the third leading cause of coma, second only to trauma and drug overdose. Over the past two decades several publications have reported the outcome of cardiopulmonary resuscitation (CPR) for inhospital cardiac arrest. Only a sparse amount of data is available concerning the initial CPR success rates and long-term survival in adult ICUs from Germany. Initial CPR success rates range from 16.8% to 44% and long-term survival to discharge from hospital ranges from 3.1% to 16.5%. Although the initial successful resuscitation rate in ICU patients may be high, long-term and hospital discharge rates have been reported to be unsatisfactory.

Objective

To evaluate the demographic characteristics of patients who suffered cardiac arrest in our ICUs as well as to identify those factors influencing outcome after resuscitation following cardiac arrest.

Methods

We reviewed the records of all patients who underwent CPR in our ICUs at the Georg-August University Hospital Göettingen, Germany from January 1999 to December 2003. The GISI database was used to search for all admissions to these ICUs, and records of patients who had CPR during their stay in the ICUs were retrieved and studied.

Results

During the study period, 169 patients underwent CPR. Eighty of the 169 patients with confirmed inhospital arrest survived to hospital discharge, giving a survival to hospital discharge rate of 47.3%. The initial monitored rhythm recorded at the time of arrest was asystole in 99 (58.6%) patients. Ventricular tachycardia/ fibrillation was recorded in 59 (34.9%) and pulseless electrical activity in seven (4.1%) patients. Forty-six (54.8% of the survivors), 31 (36.9%) and five (6.0%) patients with initial recorded asystole, VT/VF and PEA rhythms, respectively, survived to hospital discharge. Of the 80 patients that survived to hospital discharge 75 (93.8%) achieved good cerebral recovery (CPC 1 or CPC 2) and were alert and fully oriented on discharge; four patients (5.0%) were severely disabled (CPC 3), while one (1.2%) remained unconscious and was reported dead 5 days after discharge to another local hospital. Illness severity as assessed by the SAPS II score on admission was 38.8 ± 16.0. None of our patients with SAPS II score >40 24 hours after CPR survived to be discharged from the ICU.

Conclusion

Our study showed that nearly half the patients that had cardiac arrest in our hospital ICUs had a favourable outcome despite initial rhythms that are traditionally associated with a poor outcome. This confirms that good results are achievable in these groups of patients. The overall survival (47.3%) from CPR is close to that reported internationally. Advancing age, coexisting diseases and early initiation of the resuscitation protocol had significant effects on the outcome of CPR as observed in our study.