Efficacy of CPR in a general, adult ICU
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.
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Patients
In this retrospective study, we reviewed 111 consecutive patients suffering a cardiac arrest over a 2-year-period (1999–2000) in a general, adult ICU of 15 beds in a general hospital (600 beds) in Athens. Clinical data were obtained retrospectively from patients records kept in our hospital archives. Patients were admitted to the ICU from the emergency department of the hospital, were hospitalized for a variety of reasons (underlying diseases and current medical illnesses) and were all
Results
We examined the records of 111 consecutive patients suffering from cardiac arrest in an ICU environment. Their demographic characteristics, underlying diseases and current medical illness are shown in Table 1. Mean age was 56.4±1.9 years (72 males, 39 females). Illness severity, SAPS II score was 43.9±3.8 (range, 17–76).
The demographics of the patients with cardiac arrest, and the characteristics and application of CPR are shown in Table 2. As expected in an ICU arrest was witnessed in all
Discussion
In this study, we found that initially successful CPR and RCF in an ICU population may be as high as 100% in 109 patients. In two patients (1.8%) there was a DNR order according to our ICU policy. However, 24 h survival is limited to 9.2% and hospital discharge was zero.
Our DNR policy was applied to 1.8% of the patients which is significantly lower compared with that reported in the literature, being from 9 to 97%. [15], [16], [17], [18], [19]. This very low percent of DNR orders may affect our
Conclusions
Although our initial successful CPR rate is extremely high, the 24 h survival rate and survival to hospital discharge is disappointing in our ICU population. However, a more careful review of our DNR policy may improve our results. It seems that, although ICU patients are better monitored and treated in a timely fashion, they are disadvantaged by chronic underlying disease, severe current medical illness and MODS leading to a worse outcome after CPR, compared with in-ward patients.
Larger
Acknowledgements
Funded partially by the National and Kapodistrian University of Athens Special Research Account.
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