Associated Factors of In-hospital Outcomes in Emergency Department's Cardiopulmonary Resuscitation; a Cross-Sectional Study
Iranian Journal of Emergency Medicine,
Vol. 10 No. 1 (2023),
30 November 2022
,
Page e2
https://doi.org/10.22037/ijem.v10i1.40043
Abstract
Introduction: Even though the basic principles of cardiopulmonary resuscitation (CPR) are simple, the patients' outcome remains inconsistent. This study aimed to investigate the CPR outcomes and associated factors in the emergency department.
Method: This cross-sectional study was conducted on patients who underwent in-hospital CPR following a cardiac arrest in the emergency department for one year. The patient's baseline characteristics and CPR outcomes were recorded from patients' profiles, and the association of patient-related and CPR-related variables with the outcomes was assessed.
Results: 220 patients with a mean age of 71.5 ± 16.9 (range: 20-100) years were included (60.5% male). 193 cases of cardiac arrests had occurred in the hospital. Presenting cardiac rhythm in 198 cases (90.0 %) was asystole (not requiring defibrillation). The mean duration of conducted CPR was 43.2 ± 15.6 (5-120) minutes. Only 7 patients (3.2%) achieved the return of spontaneous circulation (ROSC) and were discharged from the hospital, with one suffering from neurological impairment due to CPR. There was a significant association between age (p = 0.047), consciousness status at admission (p = 0.003), presenting cardiac rhythm at CPR initiation (p = 0.0001), and establishment of ROSC under 45 minutes (p = 0.043) with patients' outcomes. Presenting cardiac rhythm at CPR initiation (p = 0.001), ROSC under 45 minutes (p = 0.012), and consciousness status at admission (p = 0.027) were independent predictive factors of survival. The area under the ROC curve for presenting cardiac rhythm and ROSC under 45 minutes was 0.817 (95% CI: 0.617-1.000) and 0.805 (95% CI: 0.606-1.000), respectively.
Conclusion: Based on the present study's findings, the survival rate of patients after CPR in ED was 3.2%. Presenting cardiac rhythm, ROSC under 45 minutes, and consciousness status at admission was among the independent predictors of mortality.
- cardiopulmonary resuscitation
- cardiac arrest
- emergency department
- survival
- associated factors
- outcome
How to Cite
References
Harris AW, Kudenchuk PJ. Cardiopulmonary resuscitation: the science behind the hands. Heart. 2018;104(13):1056-61.
Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA. 2019;321(12):1200-10.
Jayaraman R, Reinier K, Nair S, Aro AL, Uy-Evanado A, Rusinaru C, et al. Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment. Circulation. 2018;137(15):1561-70.
Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. Jama. 1960;173:1064-7.
Marinacci LX, Mihatov N, D'Alessandro DA, Villavicencio MA, Roy N, Raz Y, et al. Extracorporeal cardiopulmonary resuscitation (ECPR) survival: A quaternary center analysis. J Card Surg. 2021;36(7):2300-7.
van Gijn MS, Frijns D, van de Glind EM, B CvM, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing. 2014;43(4):456-63.
Hayashi T, Matsushima M, Bito S, Kanazawa N, Inoue N, Luthe SK, et al. Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study. Journal of general internal medicine. 2019;34(2):206-10.
Gravesteijn BY, Schluep M, Disli M, Garkhail P, Dos Reis Miranda D, Stolker RJ, et al. Neurological outcome after extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis. Crit Care. 2020;24(1):505.
Kishimori T, Matsuyama T, Kiyohara K, Kitamura T, Shida H, Kiguchi T, et al. Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest. Eur Heart J Acute Cardiovasc Care. 2020;9(4_suppl):S90-s9.
Galea S, Blaney S, Nandi A, Silverman R, Vlahov D, Foltin G, et al. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol. 2007;166(5):534-43.
Cheema MA, Ullah W, Abdullah HMA, Haq S, Ahmad A, Balaratna A. Duration of in-hospital cardiopulmonary resuscitation and its effect on survival. Indian Heart J. 2019;71(4):314-9.
Empana JP, Blom MT, Bӧttiger BW, Dagres N, Dekker JM, Gislason G, et al. Determinants of occurrence and survival after sudden cardiac arrest-A European perspective: The ESCAPE-NET project. Resuscitation. 2018;124:7-13.
Rezar R, Wernly B, Haslinger M, Seelmaier C, Schwaiger P, Pretsch I, et al. Mortality after cardiopulmonary resuscitation on a medical ICU : A sex-specific outcome analysis. Wien Klin Wochenschr. 2021;133(9-10):492-9.
Kourek C, Greif R, Georgiopoulos G, Castrén M, Böttiger B, Mongardon N, et al. Healthcare professionals' knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries. Eur J Cardiovasc Nurs. 2020;19(5):401-10.
Vestergaard LD, Lauridsen KG, Krarup NHV, Kristensen JU, Andersen LK, Løfgren B. Quality of Cardiopulmonary Resuscitation and 5-Year Survival Following in-Hospital Cardiac Arrest. Open Access Emerg Med. 2021;13:553-60.
Chen CT, Chiu PC, Tang CY, Lin YY, Lee YT, How CK, et al. Prognostic factors for survival outcome after in-hospital cardiac arrest: An observational study of the oriental population in Taiwan. J Chin Med Assoc. 2016;79(1):11-6.
Adielsson A, Djärv T, Rawshani A, Lundin S, Herlitz J. Changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest - A population-based registry study of nearly 24,000 cases. Resuscitation. 2020;157:135-40.
Stankovic N, Holmberg MJ, Høybye M, Granfeldt A, Andersen LW. Age and sex differences in outcomes after in-hospital cardiac arrest. Resuscitation. 2021;165:58-65.
Parikh PB, Hassan L, Qadeer A, Patel JK. Association between sex and mortality in adults with in-hospital and out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2020;155:119-24.
Goldberger ZD, Chan PS, Berg RA, Kronick SL, Cooke CR, Lu M, et al. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. Lancet. 2012;380(9852):1473-81.
Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. Jama. 2006;295(1):50-7.
Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med. 2010;38(1):101-8.
Høybye M, Stankovic N, Holmberg M, Christensen HC, Granfeldt A, Andersen LW. In-Hospital vs. Out-of-Hospital Cardiac Arrest: Patient Characteristics and Survival. Resuscitation. 2021;158:157-65.
Wiberg S, Holmberg MJ, Donnino MW, Kjaergaard J, Hassager C, Witten L, et al. Age-dependent trends in survival after adult in-hospital cardiac arrest. Resuscitation. 2020;151:189-96.
Adielsson A, Karlsson T, Aune S, Lundin S, Hirlekar G, Herlitz J, et al. A 20-year perspective of in hospital cardiac arrest: Experiences from a university hospital with focus on wards with and without monitoring facilities. International Journal of Cardiology. 2016;216:194-9.
Wu L, Narasimhan B, Bhatia K, Ho KS, Krittanawong C, Aronow WS, et al. Temporal Trends in Characteristics and Outcomes Associated With In-Hospital Cardiac Arrest: A 20-Year Analysis (1999-2018). J Am Heart Assoc. 2021;10(23):e021572.
Ballew KA, Philbrick JT, Caven DE, Schorling JB. Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target. Arch Intern Med. 1994;154(21):2426-32.
Shih CL, Lu TC, Jerng JS, Lin CC, Liu YP, Chen WJ, et al. A web-based Utstein style registry system of in-hospital cardiopulmonary resuscitation in Taiwan. Resuscitation. 2007;72(3):394-403.
Rohlin O, Taeri T, Netzereab S, Ullemark E, Djärv T. Duration of CPR and impact on 30-day survival after ROSC for in-hospital cardiac arrest-A Swedish cohort study. Resuscitation. 2018;132:1-5.
Hessulf F, Herlitz J, Rawshani A, Aune S, Israelsson J, Södersved-Källestedt ML, et al. Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest. Resuscitation. 2020;155:13-21.
Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care. 2011;17(3):254-9.
Geocadin RG, Eleff SM. Cardiac arrest resuscitation: neurologic prognostication and brain death. Curr Opin Crit Care. 2008;14(3):261-8.
Friberg H, Cronberg T. Prognostication after cardiac arrest. Best Pract Res Clin Anaesthesiol. 2013;27(3):359-72.
Leithner C, Ploner CJ, Hasper D, Storm C. Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest? Neurology. 2010;74(12):965-9.
- Abstract Viewed: 184 times
- pdf Downloaded: 185 times
