Hayley B Gershengorn1, Guohua Li, Andrew Kramer, Hannah Wunsch. 1. Albert Einstein College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, New York, NY 10003, USA. hgershengorn@chpnet.org
Abstract
PURPOSE: Comparatively less is known about the outcomes of cardiopulmonary resuscitation (CPR) in patients in the intensive care unit (ICU) compared with those not in an ICU. In this study, we evaluated survival rates, functional status, and predictors of good outcomes after in-ICU CPR. METHODS: We used the Project IMPACT (Cerner Corporation, Kansas City, Mo) database to conduct a retrospective cohort study of adults who underwent in-ICU CPR in the United States from 2001 to 2008. We characterized survival rates and functional outcomes and identified predictors of better prognosis using multivariate logistic regression analyses. RESULTS: Of 362074 ICU admissions, 6518 (1.8%) received in-ICU CPR with 15.7% (n = 1025) surviving to hospital discharge. Survival decreased with age, more comorbidities, and for certain admitting diagnoses, such as sepsis. Patients who survived incurred significant functional morbidity. Of survivors, only 33.6% were discharged home, and only 20.1% were functionally independent on hospital discharge. A total of 63.4% had a decrease in functional status compared with admission. Only 3.3% of all patients (21.7% of survivors) were both functionally independent and discharged home ("optimal" functional outcome). Among survivors, the risk-adjusted odds of having an optimal functional outcome decreased with age (P ≤ .022) and with failure of 3 or more organs during ICU stay (P = .006). CONCLUSIONS: Only 1 of 6 adults receiving in-ICU CPR survives to hospital discharge, and less than 5% are discharged home with independent function. Among survivors, most show large decreases in functional status compared with hospital admission.
PURPOSE: Comparatively less is known about the outcomes of cardiopulmonary resuscitation (CPR) in patients in the intensive care unit (ICU) compared with those not in an ICU. In this study, we evaluated survival rates, functional status, and predictors of good outcomes after in-ICU CPR. METHODS: We used the Project IMPACT (Cerner Corporation, Kansas City, Mo) database to conduct a retrospective cohort study of adults who underwent in-ICU CPR in the United States from 2001 to 2008. We characterized survival rates and functional outcomes and identified predictors of better prognosis using multivariate logistic regression analyses. RESULTS: Of 362074 ICU admissions, 6518 (1.8%) received in-ICU CPR with 15.7% (n = 1025) surviving to hospital discharge. Survival decreased with age, more comorbidities, and for certain admitting diagnoses, such as sepsis. Patients who survived incurred significant functional morbidity. Of survivors, only 33.6% were discharged home, and only 20.1% were functionally independent on hospital discharge. A total of 63.4% had a decrease in functional status compared with admission. Only 3.3% of all patients (21.7% of survivors) were both functionally independent and discharged home ("optimal" functional outcome). Among survivors, the risk-adjusted odds of having an optimal functional outcome decreased with age (P ≤ .022) and with failure of 3 or more organs during ICU stay (P = .006). CONCLUSIONS: Only 1 of 6 adults receiving in-ICU CPR survives to hospital discharge, and less than 5% are discharged home with independent function. Among survivors, most show large decreases in functional status compared with hospital admission.