K Khalafi1, K Ravakhah, B C West. 1. Department of Medicine, Huron Hospital, 13951 Terrace Road, Cleveland, OH 44112, USA. khalafi@hotmail.com
Abstract
PURPOSE: To identify patients who should not have resuscitation started or continued. DESIGN: Multi-disciplinary prospective study. SUBJECTS: Two hundred forty-one consecutive patients with cardiopulmonary arrests from January 1995 to February 1997 were evaluated, of which 200 were studied. METHODS: Subjects were studied for age, sex, arrest location, CPR duration, recovery from arrest, hospital discharge, 6 weeks' survival, sepsis and co-morbid conditions. RESULTS: Overall 69 (34.5%) recovered from the arrest, 24 (12.0%) left the hospital, and 17 (8.5%) survived 6 weeks. Of inpatients, 13.7% (16/117) were alive at 6 weeks in contrast to 1.2% (1/83) of field/emergency room (ER) arrests. Sepsis did not lessen the immediate recovery rate; however, none of 25 septic patients survived hospitalization. Outcomes were not different between men and women or regular floor and ICU/CCU arrests. Age of survivors was the same as non-survivors. Survivors were resuscitated for 18.7+/-16.5 min and non-survivors 33.1+/-18.4 min (P=0.15). The initial rhythm of asystole or the presence of three or more co-morbid conditions had a negative prognosis. CONCLUSION: CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.
PURPOSE: To identify patients who should not have resuscitation started or continued. DESIGN: Multi-disciplinary prospective study. SUBJECTS: Two hundred forty-one consecutive patients with cardiopulmonary arrests from January 1995 to February 1997 were evaluated, of which 200 were studied. METHODS: Subjects were studied for age, sex, arrest location, CPR duration, recovery from arrest, hospital discharge, 6 weeks' survival, sepsis and co-morbid conditions. RESULTS: Overall 69 (34.5%) recovered from the arrest, 24 (12.0%) left the hospital, and 17 (8.5%) survived 6 weeks. Of inpatients, 13.7% (16/117) were alive at 6 weeks in contrast to 1.2% (1/83) of field/emergency room (ER) arrests. Sepsis did not lessen the immediate recovery rate; however, none of 25 septic patients survived hospitalization. Outcomes were not different between men and women or regular floor and ICU/CCU arrests. Age of survivors was the same as non-survivors. Survivors were resuscitated for 18.7+/-16.5 min and non-survivors 33.1+/-18.4 min (P=0.15). The initial rhythm of asystole or the presence of three or more co-morbid conditions had a negative prognosis. CONCLUSION:CPR survival is problematic, and it is especially poor in field/BR arrests. Emergency squads should terminate CPR for pulseless patients after communicating with the ER physician. Age is not a determinant of recovery or survival. Arrest outside of the hospital, sepsis, three or more co-morbid conditions, previous CPR, asystole or resuscitation for >25 min all decrease the chance of hospital discharge and survival. Instituting or continuing CPR in a great majority of these patients is futile. Families should be so advised.
Authors: Ross J Fleischman; Richard J Mullins; K John McConnell; Jerris R Hedges; O John Ma; Craig D Newgard Journal: J Trauma Acute Care Surg Date: 2012-07 Impact factor: 3.313
Authors: Abdullah Mohammed Kaki; Kamal Waheeb Alghalayini; Mohamed Nabil Alama; Adnan Abdullah Almazroaa; Norah Abdullah A Khathlan; Hassan Sembawa; Beena M Ouseph Journal: Saudi J Anaesth Date: 2017 Oct-Dec