Efficacy of CPR in a general, adult ICU

Abstract

Aim: To investigate the initial cardiopulmonary resuscitation (CPR) success rate and long term survival in an Intensive care unit (ICU) population. Patients: All patients with cardiac arrest over a 2-year-period (1999–2000) in a general, adult ICU of a general hospital of Athens. Methods: Retrospective collection of clinical data concerning patients, CPR characteristics and survival rates. Results: We examined 111 ICU patients, aged 56.4±1.9 years (72 males). SAPS II score was 43.9±3.8. CPR was performed in 98.2% of the patients within 30 s. Initial restoration of cardiac function (RCF) and successful CPR rate was 100% while 24 h survival was 9.2%. Survivors at 24 h were younger, mainly males, with lower SAPS II score, mainly with pulmonary disease, ventricular fibrillation or ventricular tachycardia (8/10) and initial pupil reactivity (5/10). Four patients required more than one cycle of CPR. Survival to discharge was zero. Conclusion: Although the initial successful CPR rate in ICU patients may be high, long term survival and hospital discharge is disappointing. Although ICU patients are better monitored and treated in a timely fashion, they are disadvantaged by chronic underlying diseases, severe current medical illnesses and multi organ dysfunction syndrome (MODS) leads to worst outcome after CPR compared with in-ward patients.

Sumàrio

Objectivo: Investigar a taxa de sucesso da CPR inicial e sobrevivência a longo termo numa população de uma Unidade de Cuidados Intensivos (ICU). Pacientes: Todos os doentes vı́timas de paragem cardı́aca durante um perı́odo de 2 anos (1999–2000) numa ICU polivalente de adultos de um hospital de Atenas. Método: Recolha retrospectiva de dados clı́nicos relativos aos doentes, caracterı́sticas de CPR e taxa de sobrevivência. Resultados: Foram examinados 111 doentes dos ICU, com idade média 56.4±1.9 anos ( 72 homens). O score SAPS II foi de 43.9±3.8. Foi iniciada CPR em 98.2% dos pacientes em 30 s. A Recuperação inicial da Função Cardı́aca (RFC) e a taxa de sucesso da CPR foi de 100%, enquanto que a sobrevivência às 24 horas foi 9.2%. Os sobreviventes às 24 h foram jovens, principalmente homens, com baixos scores de SAPS II, principalmente com doença pulmonar, fibrilhação ventricular ou taquicardia ventricular (8/10) e reactividade pupilar inicial (5/10). Quatro doentes necessitaram de mais de 1 ciclo de CPR. A taxa de sobrevivência à alta foi de zero. Conclusão: Embora a taxa de sucesso inicial de CPR nos pacientes dos ICU possa ser alta, a sobrevivência a longo termo e a alta hospitalar é desapontadora. Embora os doentes dos ICU sejam melhor monitorizados e tratados de uma forma atempada, eles estão em desvantagem pela doença subjacente; doenças médicas severas concomitantes e sı́ndrome de disfunção multiorgânica (MODS) condicionam um pior outcome após CPR comparativamente com os doentes das enfermarias gerais.

Resumen

Objetivo: Investigar la tasa de éxito inicial de la resucitación cardiopulmonar (RCP) y la sobrevida a largo plazo en una población en una unidad de cuidados intensivos (ICU). Pacientes: todos los pacientes con paro cardı́aco en un perı́odo de 2 años (1999–2000) en una UCI de adultos de un hospital general de Atenas. Métodos: recolección retrospectiva de datos clı́nicos concernientes a pacientes, caracterı́sticas de la RCP y tasas de sobrevida. Resultados: Examinamos 111 pacientes de UCI, con edades entre 56.4±1.9 años (72 varones). El puntaje de SAPS II fue de 43.9±3.8. En el 98.2% de los pacientes se inicio la RCP antes de 30 segundos. El restablecimiento inicial de la función cardı́aca (RCF) y la tasa de éxito de la RCP fue 100% mientras que la sobrevida de 24 horas fue 9.2%. Los sobrevivientes a las 24 horas eran mas jóvenes, principalmente varones, con menores puntajes de SAPS II, principalmente con enfermedad pulmonar, fibrilación ventricular o taquicardia ventricular (8/10) y reactividad pupilar inicial (5/10). Cuatro pacientes requirieron más de un ciclo de RCP. La sobrevida al alta fue cero. Conclusión: Aunque la tasa inicial de éxito de la RCP puede ser alta, la sobrevida a largo plazo y al alta hospitalaria es desalentadora. Aunque los pacientes de ICU están mejor monitorizados y tratados con respecto al tiempo, tienen las desventajas de enfermedades crónicas subyacentes, enfermedades actuales severas y sı́ndrome de disfunción orgánica múltiple(MODS) lo que lleva a un peor resultado después de la RCP al compararlos con pacientes de sala.

Introduction

During recent decades, there have been significant efforts and many advances published in cardiopulmonary resuscitation (CPR), advanced life support (ALS) and emergency cardiovascular care (ECC) in order to restore circulation and improve survival for victims having either in- or out-of-hospital cardio pulmonary arrest [1], [2].

Several factors may affect outcome for in-hospital, in-ward cardiac arrest patients. These include time to start resuscitation, pre-arrest status, (sepsis, hypotension, renal failure, pneumonia, low functional status, metastatic cancer), illness severity, duration of resuscitation, time of arrest during the day, and initial cardiac rhythm [3], [4], [5], [6], [7], [8].

Less is known concerning initial CPR success rates and the effect of CPR on long term survival in adult intensive care unit (ICU) patients and the small number of studies performed up to now are more or less inconclusive. In such a population, illness severity has a significant predictive value on death after CPR. Initial CPR success ranges from 16.8 to 44% and long-term survival to discharge from hospital ranges from 3.1 to 16.5% [5], [9], [10], [11], [12], [13], [14].

The purpose of this study was to examine the demographic characteristics of the patients having a cardiac arrest episode in an ICU at a general hospital in Greece. We also set out to examine the characteristics and the efficacy of CPR and ALS in critically ill ICU patients. Finally we examined the characteristics of the patients surviving after CPR.