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in-hospital cardiopulmonary resuscitation (CPR)

Epidemiology: - figures for adults > 65 years of age - incidence: 2.73 events per 1000 admissions - survival to hospital discharge is 22% [7,8]; 12.5% [11] - neurologic deficits among survivors is 28% [7,8] - long-term survival rates (2000-2008) - 59% at 1 year, 50% at 2 years, & 44% at 3 years - 1/2 of patients with mild or no neurological disability - survival lower among older vs younger patients, among men vs women & among blacks vs whites [3] - hospital deaths preceded by CPR = 5.2% - CPR survivors discharged home = 40% (distinguished from discharge to nursing home or hospice) - blacks were consistently more likely than whites to receive in-hospital CPR & to receive CPR prior to death & were less likely to survive to discharge after CPR - ref [7] & [10] uses a GO-FAR scoring system that assigns a likelihood of good outcome ranging from < 1% to > 15% [7,10] - survival rate was lower among patients who were - men - older - had more coexisting illnesses - admitted from a skilled-nursing facility [1] Management: - endotracheal intubation during in-hospital cardiopulmonary resuscitation reduces survival to discharge (16 vs 19%) [9] - predication model for prognosis uses (points) [4] - age (60-69 1, 70-70 2, >= 80 4) - initial rhythm & time to defibrillation - PEA & asystole 6-7 points, otherwise 0-3 points - pre-arrest cerebral performance category - up to 9 points - location in hospital (telemetry, ICU, ward) - ward 3 points, ICU point - duration of resuscitation - 5-9 minutes 3 points, >= 15 minutes 6 points - other factors - renal insufficiency (2 points) - hepatic insufficiency (4 points) - sepsis (3 points) - malignancy (5 points) - hypotension (4 points)

General

cardiopulmonary resuscitation (CPR)

References

  1. Ehlenbach WJ et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009 Jul 2; 361:22 PMID: 19571280
  2. Chan PS et al Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009 Sep 16;302(11):1195-201. PMID: 19755698
  3. Chan PS et al. Long-term outcomes of elderly survivors of in-hospital cardiac arrest. N Engl J Med 2013 Mar 14; 368:1019. PMID: 23484828
  4. Girotra S, Nallamothu BK, Chan PS. Using risk prediction tools in survivors of in-hospital cardiac arrest. Curr Cardiol Rep. 2014 Mar;16(3):457. PMID: 24464303 http://download.springer.com/static/pdf/941/art%253A10.1007%252Fs11886-013-0457-0.pdf?auth66=1415384443_59d818f3c66402eabab42746dd073419&ext=.pdf
  5. Ebell MH, Jang W, Shen Y, Geocadin RG; Get With the Guidelines-Resuscitation Investigators. Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med. 2013 Nov 11;173(20):1872-1878. PMID: 24018585
  6. Ramenofsky DH, Weissman DE. #179 CPR Survival in the Hospital setting. EPERC Fast Facts and Concepts #179. Medical College of Wisconsin http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_179.htm
  7. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  8. Girotra S, Nallamothu BK, Spertus JA et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012 Nov 15;367(20):1912-20. PMID: 23150959 Free PMC Article
  9. Andersen LW et al. Association between tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA 2017 Feb 7; 317:494. PMID: 28118660 - Angus DC. Whether to intubate during cardiopulmonary resuscitation: Conventional wisdom vs big data. JAMA 2017 Feb 7; 317:477 PMID: 28118658
  10. Anderson WG, Chase R, Pantilat SZ, Tulsky JA, Auerbach AD. Code status discussions between attending hospitalist physicians and medical patients at hospital admission. J Gen Intern Med. 2011 Apr;26(4):359-66 PMID: 21104036 Free PMC Article
  11. Girotra S et al. Survival after in-hospital cardiac arrest in critically ill patients: Implications for COVID-19 outbreak? Circ Cardiovasc Circ Cardiovasc Qual Outcomes. 2020. PMID: 32438836 https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006837 - Girotra S, et al. Survival After In-Hospital Cardiac Arrest In Critically Ill Patients: Implications For The Covid-19 Pandemic? medRxiv. 2020. PMID: 32511438 Free PMC article.