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 with survival to the time of hospital discharge.

DESIGN

A 2-year prospective cohort study.

SETTING

Foothills Medical Centre, a 700-bed tertiary, academic and regional referral centre for Calgary and southern Alberta.

PATIENTS: Adult inpatients, excluding those who had cardiac arrest in the Emergency Department or operating room.

INTERVENTION: Cardiac resuscitation.

MAIN OUTCOME MEASURES: Spontaneous return of the pulse with a minimum systolic 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 resuscitation team was in attendance. Of 239 resuscitated patients, 51 (21.3%) survived. Fifteen variables were identified as being associated with survival. This association could be explained, through multivariate analysis, by the effect of the following 3 variables (odds ratio [OR], 95% confidence interval [CI]): initial observed rhythm other than pulseless electrical activity or asystole (OR 17.34, 95% CI 8.2 to 36.8); a patient who was ambulatory and able to provide self-care (OR 3.8, 95% CI 1.9 to 7.5); and a spontaneous 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 static. Initial cardiac rhythm and duration of resuscitation before spontaneous return of circulation were the most important risk factors for survival. These factors and the patient's functional status are relevant when discussing cardiac resuscitation with patients or when considering whether to discontinue resuscitation efforts.