Advanced cardiac life support events in a community hospital and their outcome: evaluation of actual arrests

• Published in: Resuscitation 1998-02, Vol.36 (2), p.95-99
• Main Authors: Ravakhah, Keyvan, Khalafi, Kamal, Bathory, Tamas, Wang, Hsien C
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bypass surgery; Cardiopulmonary arrest; Cardiopulmonary Resuscitation; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart Arrest - mortality; Heart Arrest - therapy; Hospitals, Community; Humans; Intensive care medicine; Male; Medical sciences; Prognosis; Resuscitation; Retrospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/S0300-9572(98)00003-3

To evaluate resuscitation efforts for patients with cardiac and/or pulmonary arrest in our hospital a retrospective study was conducted and compared with available data from other community teaching hospitals. Records of 131 consecutive patients of ages 16–98 who received resuscitation according to Advanced Cardiac Life Support protocols were reviewed. Short-term survival (return of spontaneous circulation) and discharge-from-the-hospital survival were measured. Nineteen patients (15%) were excluded from the study because the information recorded on the code record sheet was insufficient. Overall short-term survival rate was 34.8%. Resuscitations in the Emergency Room were evaluated separately, because most of them were initiated outside of the hospital. Their short-term survival was 14%, but none of them survived to be discharged. Out of 69 inpatient resuscitative efforts, 33 were successful (47.8%). Of these 33, nine (13.0%) left the hospital. The rest expired during the same hospitalization. Short-term survival for patients after coronary artery bypass graft surgery was 60% (6 of 10) and 30% (3 of 10) were discharged home. Forty percent of official code records were incomplete. We concluded that better education and more emphasis on record-keeping are mandatory, with the main burden falling upon the nurse in charge to have received more precise instruction. Contrary to published data, women did not have a better survival than men ( P>0.05). There was no difference in outcomes between resident physician directed codes compared to attending physician directed codes ( P>0.05). The mean age of inpatient short-term survivors was 69.0 (±13.2) years and that of non-survivors 69.8 (±15.7) years ( P>0.05). Post-bypass surgery patients had a better survival than non-surgical patients, but the difference was not significant ( P>0.05). Survival in our hospital was comparable to one hospital and worse than another (34.8% vs. 39.6% or 63.0%). Despite success, prognosis after arrest remains poor.