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PubMed1996

Acadesine and lipopolysaccharide-evoked pulmonary dysfunction after resuscitation from traumatic shock.

BACKGROUND: We have reported that the purine precursor acadesine (AICAR) improved the microcirculation, repleted adenosine triphosphate, and attenuated local and lung neutrophil infiltration after intestinal reperfusion and that it quickly improved systemic hemodynamics after resuscitation from hemorrhagic shock. This study evaluated the therapeutic potential of AICAR after fluid resuscitated trauma. METHODS: Anesthetized (fentanyl) mongrel pigs were subjected to tissue injury plus hemorrhage and randomized to receive resuscitation fluids comprised of shed blood plus either lactated Ringer's solution (LR) or AICAR (1 or 10 mg/kg bolus + 0.5 mg/kg/min x 30 min). Thereafter either LR or AICAR (1 or 10 mg/kg) was administered at 12-hour intervals for 72 hours. In a smaller series (n = 7) a single bolus (0.5 mg/kg) of the adenosine deaminase inhibitor deoxycoformycin was administered at the time of resuscitation. After 72 hours, and endotoxin challenge (0.5 microgram/kg, lipopolysaccharide [LPS]) was administered. RESULTS: At 1 mg/kg (n = 9), AICAR had no obvious effect versus LR (n = 31). At 10 mg/kg AICAR (n = 11), the fluid required to stabilize hemodynamics after trauma was higher (66 +/- 5 versus 52 +/- 3 ml/kg/hr, p = 0.014), but there were fewer deaths 3 days after trauma versus LR (0 of 11 versus 4 of 31, p = 0.210), fewer deaths within 5 hours after LPS administration (3 of 11 versus 16 of 27, p = 0.074), and a longer survival time after LPS administration (4.5 +/- 0.3 versus 3.9 +/- 0.2 hr, p = 0.054). Deoxycoformycin had similar salutary effects on survival after LPS administration. LPS increased protein permeability of pulmonary capillaries, increased peak inspiratory pressures on constant tidal volume, increased dead space ventilation, and caused progressive arterial desaturation on 0.65 FiO2 (all p < 0.05). This pulmonary dysfunction was associated with a compensatory increase in cardiac output, decrease in systemic vascular resistance, increase in O2 consumption, and rise in plasma cortisol level (all p < 0.05). All these changes were blunted or eliminated with 10 mg/kg AICAR. Hematocrit and systemic pressures were maintained relatively constant after LPS administration with fluid resuscitation, but less was required with AICAR versus LR (40 +/- 8 versus 83 +/- 14 ml/kg/hr, p = 0.023). AICAR caused a concentration-related reduction in CD18 expression on LPS-stimulated neutrophils in vitro, but there was no effect versus LR on circulating leukocyte counts in vivo and no effect of AICAR on LPS-stimulated production of tumor necrosis factor in vitro or in vivo. CONCLUSIONS: 1. AICAR reduced the pulmonary dysfunction associated with posttrauma endotoxemia but had no effect on circulating leukocytes, so its mechanism could be related to an adenosine-mediated improvement in peripheral perfusion or O2 use. 2. AICAR is a generic compound that is safe and apparently efficacious in human beings, so AICAR prophylaxis could be cost-effectively administered to trauma patients.

Adenosine↗
PubMed1996

Metallothionein and HSP-72 are induced in the liver by hemorrhagic shock and resuscitation but not by shock alone.

BACKGROUND: Previous reports have indicated that HSP-72 and metallothionein mRNA undergo induction in the liver after resuscitated hemorrhagic shock. In this study we investigated whether unresuscitated shock triggers induction and whether protein induction also occurs. METHODS: Rats were subjected to resuscitated and unresuscitated shock protocols of varying severity; livers were isolated and processed for Northern, Western, and immunohistochemical analysis. Cadmium binding assay was used to measure metallothionein protein. RESULTS: Unresuscitated shock led to no induction of HSP-72 or metallothionein. Severe resuscitated shock led to prompt induction of HSP-72 mRNA and protein in hepatocytes, up to 20-fold over sham group; metallothionein mRNA induction appeared later than HSP-72 and did not lead to elevated protein levels. Mild resuscitated shock had little effect. CONCLUSIONS: These findings indicate resuscitated severe shock, not shock alone, leads to induction of HSP-72 and metallothionein in the liver. Metallothionein expression lags behind HSP-72 expression.

Animals↗
PubMed1995

Nasal route for infant resuscitation by mothers.

In infants under 6 months of age air normally enters the trachea by the nose because the tongue fills the oral cavity, and the oral route is open only when the infant is making muscular efforts such as crying or gasping. The present recommendation for infant resuscitation is for the resuscitator's mouth to cover the mouth and nose of the baby. We set out to test whether this recommendation is feasible. We measured the dimensions of the faces of 28 babies aged between 2 and 4 months (the age when resuscitation is most often needed) and of the mouths of 25 of their mothers. Only 2 mothers would have been able to cover with their mouths the nose and closed mouth of 2 babies (not their own). The mannequins often used to teach adults to resuscitate infants are misleading because they present a wide open mouth, thus implying that that is the preferred route. We recommend that the nasal route of air entry be taught to parents for resuscitation of babies who have stopped breathing.

Cardiopulmonary Resuscitation↗
PubMed1995

The delivery room resuscitation of the hydropic neonate.

Hydrops fetalis is a relatively rare disorder that will be encountered occasionally in all obstetric centers. The prognosis for infants with hydrops fetalis is poor, with mortality reported in the range of 50% to 98%. The effectiveness of delivery room resuscitation and the ability to achieve early adequate gas exchange in affected infants may be related to survival. Successful resuscitation requires an understanding of transitional neonatal physiology and the potential impact of hydrops fetalis, an experienced and well-prepared resuscitation team, meticulous attention to technical aspects of resuscitation, and careful assessment and monitoring of the infant during resuscitation.

Delivery Rooms↗
PubMed1993

Accuracy of bar codes versus handwriting for recording trauma resuscitation events.

STUDY OBJECTIVES: To compare the accuracy of computerized bar code data entry with conventional handwritten data entry during videotaped trauma resuscitations. SETTING: Laboratory; video simulation. TYPE OF PARTICIPANTS: Twenty-four emergency nurses. DESIGN: The nurses viewed videotapes of four different major trauma resuscitations during a single session. Each nurse recorded resuscitation events by handwritten entry in two cases and by bar code entry in another two. A computerized bar code system was designed specifically for contemporaneous charting of rapidly occurring events during trauma resuscitations. The handwritten and bar-coded records then were compared with a master list of events, and the number of entry errors were counted. Errors were defined as "omissions" (failing to record an event), "commissions" (recording an event that did not occur), or "inaccuracies" (errors in recording details of an event). ANALYSIS: Differences in the number of entry errors between the two recording methods were compared using unpaired t-tests. Differences in the number of errors after adjusting for the different nurses, different case being viewed, and order of viewing were analyzed using balanced analysis of variance techniques. P < .05 was considered significant. MAIN RESULTS: The mean +/- SEM number of total errors per record for bar codes was 2.63 +/- 0.24 compared with 4.48 +/- 0.30 for handwriting (P < .0001). The mean number of omissions per record for bar codes was 2.25 +/- 0.21 compared with 3.65 +/- 0.27 for handwriting (P = .0001). The mean number of inaccuracies per record for bar codes was 0.38 +/- 0.10 compared with 0.83 +/- 0.12 for handwriting (P = .0038). There were no commission-type errors. CONCLUSION: Computerized bar code data entry of trauma resuscitation events had significantly fewer entry errors than handwritten data entry in a laboratory setting. Potential advantages of bar code data entry include keyless data entry, automatic time-stamping, standardization of documentation, legibility of the medical record, and "point-of-care" data capture.

Electronic Data Processing↗
PubMed1982

Emergency diagnosis, resuscitation, and treatment of acute penetrating cardiac trauma.

The controversy concerning the mode of resuscitation in acute penetrating cardiac trauma has been resolved in recent years. Most large centers are aggressive, and pericardiocentesis is used in life-threatening situations only as a temporary measure until thoracotomy can be performed. There are at least 32 publications which recommended emergency department thoracotomy for resuscitation of the critically injured heart. The physician should be alerted when patients arrive with penetrating chest and upper abdominal wounds. Cardiac injury must be ruled out as soon as possible, for minutes may mean the difference between successful resuscitation and irreversible myocardial damage. Most penetrating chest wounds are easily managed in the emergency department with fluid resuscitation and chest tube drainage. Patients who have an isolated penetrating cardiac injury will have the best prognosis; moribund patients who are suffering from extrathoracic injuries, especially CNS injuries, will have a dismal prognosis. The keys to successful resuscitation of the traumatized heart are a high index of suspicion, early recognition, and rapid intervention.

Cardiac Tamponade↗
PubMed1999

Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias?

STUDY OBJECTIVE: Early countershock of ventricular fibrillation (VF) has been shown to improve immediate and long-term outcome of out-of-hospital cardiac arrest. However, studies indicate that countershock of prolonged VF most commonly results in asystole or a nonperfusing bradyarrhythmia (pulseless electrical activity [PEA]), which rarely respond to current therapy. The cause of these postcountershock rhythm disturbances is not well understood but may be related to electrical injury of the globally ischemic myocardium or to local metabolic abnormalities that impair impulse formation and cardiac contraction. The purpose of this study was to evaluate changes in serum potassium and free calcium homeostasis during cardiac arrest and advanced cardiac life support (ACLS) interventions. METHODS: After sedation, intubation, anesthesia, and instrumentation, VF was induced in 13 dogs. After 7.5 minutes of VF, animals were immediately countershocked, standard closed-chest CPR was initiated, and epinephrine was administered (1 mg in repeated doses if necessary). RESULTS: Ten animals could not be resuscitated despite 20 minutes of ACLS interventions. In these animals, a progressive increase in serum potassium was observed from the onset of ACLS to the termination of resuscitation efforts (4.3+/-.6 to 6.0+/-.8 mEq/L, P<.01). A significant increase was observed within 10 minutes of beginning ACLS measures. This was accompanied by a decrease in ionized calcium concentration over the same period (4.95+/-.40 to 3.44 mg/dL, P<.01). The decrease in ionized calcium was significant within 5 minutes of ACLS interventions. Nine of these 10 animals had either postcountershock asystole or PEA at the termination of resuscitative efforts. The increase in potassium was not related to acidemia. Successfully resuscitated animals did not demonstrate these electrolyte changes. CONCLUSION: Ionized hypocalcemia and hyperkalemia occur during prolonged resuscitative efforts and may be related to dysfunctional transcellular ionic transport mechanisms. These cations play important roles in cardiac electrical and contractile activity and may play a role in refractory postcountershock rhythm disturbances.

Animals↗
PubMed2002

Improved resuscitation training of senior house officers in oral and maxillofacial surgery.

All healthcare professionals are expected to be competent at cardiopulmonary resuscitation. In a previous study [Br J Oral Maxillofac Surg 1999; 37: 1], senior house officers in oral and maxillofacial surgery (OMFS) expressed dissatisfaction about their training in resuscitation, and we now report the results of a follow-up survey. The amount of training in resuscitation has increased in the 5 years since the initial questionnaire, and 77% of the 73 respondents (n=56) been given such training in the 12 months before the present survey, compared to 48% in the previous study. Fifty-one (70%) now think that they would feel confident if required to resuscitate a patient who had a cardiorespiratory arrest, and this has increased from 47%. Despite this, 70 (96%) of senior house officers in OMFS stated that they wanted further training in cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗
PubMed1999

[Guidelines of the Spanish Society of Cardiology for cardiopulmonary resuscitation].

Cardiac arrest, consistent on cessation of cardiac mechanical activity, is diagnosed in the absence of consciousness, pulse and breath. The totality of measurements applied to revert it is called cardiopulmonary resuscitation. Two different levels can be distinguished: basic vital support and advanced cardiac vital support. In the basic vital support methods which do not require special technology are used: opening of air lines, mouth to mouth ventilation, cardiac massage; recently, there is a tendency to include the use of defibrillator. Advanced cardiac vital support should be the continuation of basic vital support. In this situation defibrillator, venous cannulation, orotracheal intubation, mechanical ventilation with high content in oxygen and drugs are used. Before beginning cardiopulmonary resuscitation, one should make sure that a real cardiac arrest is present, less than 10 min have elapsed, the victim does not have an immediately fatal prognosis and there is no deny by the victim or his/her family to receive cardiopulmonary resuscitation. In case of doubt it should be always practised. It is important to know the diagnosis and prognosis of the cause of cardiac arrest as soon as possible, in order to treat it and decide if the maneuvers should be continued. Hydro-electrolytic disturbances must be treated and neurological damage after cardiopulmonary resuscitation must be assessed. Only 20% of patients who recover an effective cardiac rhythm after cardiopulmonary resuscitation are discharged from hospital without neurological sequelae.

Cardiopulmonary Resuscitation↗
PubMed2000

Minimally invasive direct cardiac massage versus closed-chest cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation cardiac arrest.

Open chest cardiac massage has been shown to be superior to closed-chest cardiopulmonary resuscitation for both hemodynamics produced during resuscitation and ultimate resuscitation success. The inexperience of many rescuers with emergency thoracotomy, along with the associated morbidity contributes to the continued reluctance in the use of invasive cardiopulmonary resuscitation techniques. A device has been developed for performing 'minimally invasive' direct cardiac massage. This technique was compared to standard closed-chest CPR for resuscitation results in 20 swine during prolonged ventricular fibrillation cardiac arrest. Minimally invasive direct cardiac massage was superior to closed-chest CPR for return of spontaneous circulation (7/10 vs. 2/10; P<0.02) and coronary perfusion pressure at 30 min of CPR (17+/-9 vs. 6+/-6 mmHg; P<0.05). No significant injuries altering outcome were found with the invasive device. Throughout most of the time course of the study no significant differences in end-tidal expired carbon dioxide levels were noted. Nor were there any differences in 24-h survival. Improvements in assuring proper placement of the device on the epicardium should make this technique a potent advanced cardiac life support adjunct.

Analysis of Variance↗
PubMed2000

Part 9: pediatric basic life support. European Resuscitation Council.

The epidemiology and outcome of pediatric cardiopulmonary arrest and the priorities, techniques, and sequence of pediatric resuscitation assessments and intervention differ from those of adults. Current guidelines have been updated after extensive multinational evidence-based review and discussion over several years. Areas of controversy in current guidelines and recommendations made by consensus are detailed. A large degree of uniformity exists in the current guidelines advocated by the AHA, Council on Latin American Resuscitation, Heart and Stroke Foundation of Canada, European Resuscitation Council, Australian Resuscitation Council, and Resuscitation Council of Southern Africa. Differences are currently based on local and regional preferences, training networks, and customs rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted.

Algorithms↗
PubMed2001

Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic.

Survival from out-of-hospital resuscitation depends on the strength of each component of the chain of survival. We studied, on the scene, witnessed, nontraumatic resuscitations of patients older than 17 years. The influence of the chain of survival and potential predictors on survival was analyzed by logistic regression modeling. From 1030 patients, 139 survived to hospital discharge. Three prediction models of survival were developed from the perspective of the different contributors active in out-of-hospital resuscitation: model I, bystanders; model II, first responders; and model III, paramedics. Predictors for survival (with odds ratio) were: in model I (bystanders): emergency medical service (EMS) witnessed arrest (0.50), delay to basic cardiopulmonary resuscitation (CPR) (0.74/min) and delay to EMS arrival (0.87/min); in model II (first responders): initial recorded heart rhythm (0.02 for nonshockable rhythm), delay to basic CPR (0.71/min and 0.87/min for shockable and nonshockable rhythms) and to defibrillation (0.89/min), and in model III (paramedics): need for advanced CPR (4.74 for advanced CPR not-needed), initial recorded heart rhythm (0.05 for nonshockable rhythm), and delay to basic CPR (0.77/min and 0.72/min for shockable and nonshockable rhythms), to defibrillation and to advanced CPR for shockable rhythms (0.85/min), and to advanced CPR for nonshockable rhythm (0.85/min). The area under the receiver-operator characteristic curve for model I was 0.763, for model II was 0.848, and for model III was 0.896. Of survivors, 50% had restoration of circulation without need for advanced CPR. Three survival models for witnessed nontraumatic out-of-hospital resuscitation based on the information known by bystanders, first responders and paramedics explained survival with increasing precision. Early defibrillation can restore circulation without the need for advanced CPR. When advanced CPR is needed, its delay leads to a markedly reduced survival.

Adolescent↗
PubMed2002

Resuscitation from cardiac arrest with adrenaline/epinephrine or vasopressin: effects on intestinal mucosal tonometer pCO(2) during the postresuscitation period in rats.

BACKGROUND: The use of vasopressin instead of adrenaline/epinephrine during resuscitation improves vital organ perfusion, but the effects on mesenteric perfusion following successful resuscitation are not fully evaluated. The present study was designed to compare the effects of vasopressin and adrenaline/epinephrine, given to rats during resuscitation from ventricular fibrillation, on to mesenteric ischaemia, as determined by intestinal mucosal tonometer pCO(2) during the postresuscitation period. METHODS AND RESULTS: Male Sprague-Dawley rats (n=28) were allocated randomly to receive vasopressin (0.8 U/kg) or adrenaline/epinephrine (90 microg/kg) after 5 min of ventricular fibrillation. Precordial chest compression was initiated 4 min after the start of ventricular fibrillation, continued for 4 min, and followed by defibrillation. Seven of 14 (vasopressin) and 12 of 14 (adrenaline/epinephrine) rats were successfully defibrillated (P=0.10, Fisher's exact test) and observed for 60 min. Intestinal mucosal tonometer pCO(2) measurements before cardiac arrest and 15, 30, and 60 min following return of spontaneous circulation were 47+/-3, 73+/-8, 63+/-7, and 56+/-6 mmHg in the vasopressin group and 48+/-5, 78+/-7, 67+/-6, and 62+/-6 mmHg in the adrenaline/epinephrine group (P<0.05 at 60 min between vasopressin and adrenaline/epinephrine). Right atrial hemoglobin oxygen saturations at these time points were 73+/-5, 51+/-12, 58+/-11, and 63+/-5% in the vasopressin group and 76+/-7, 44+/-10, 52+/-10 and 54+/-8% in the adrenaline/epinephrine group (P<0.05 at 60 min between vasopressin and adrenaline/epinephrine). CONCLUSIONS: We conclude that in this rat model the administration of vasopressin instead of adrenaline/epinephrine for CPR tends to be associated with lower resuscitation success, but less mesenteric ischaemia during the postresuscitation period in successfully resuscitated rats.

Adrenergic Agonists↗
PubMed2002

Resuscitation of hemorrhagic shock attenuates intrapulmonary nitric oxide formation.

Hemorrhagic shock has been shown to upregulate intrapulmonary inducible nitric oxide (NO) synthase (iNOS) expression. Increased intrapulmonary iNOS expression is reflected by increases in concentrations of NO in the airways. The purpose of this study was to examine the effects of resuscitation on this induction of intrapulmonary NO formation caused by hemorrhage. Eighteen rats were randomized to one of three groups. One group of rats was simply sham-instrumented and monitored. Two other groups experienced hemorrhagic shock (mean systemic blood pressure of 40-45 mmHg) for 60 min. In one of the hemorrhagic shock groups, resuscitation was performed by re-infusing the shed blood and supplementing it with normal saline. Compared with sham-instrumented rats, those exposed to hemorrhagic shock without subsequent resuscitation exhibited a 10-fold increase in exhaled NO concentrations. Additionally, concentrations of both intrapulmonary iNOS protein and mRNA increased. Resuscitation attenuated the hemorrhage-induced upregulation of exhaled NO, iNOS protein and iNOS mRNA. This data suggests that resuscitation attenuates the hemorrhagic shock-induced formation of intrapulmonary NO by downregulating iNOS transcription. We believe that exhaled NO concentrations provide a useful, non-invasive method of monitoring the intrapulmonary inflammatory sequelae of hemorrhagic shock.

Analysis of Variance↗
PubMed2003

Optimizing bag-valve-mask ventilation with a new mouth-to-bag resuscitator.

When ventilating an unintubated patient with a self-inflating bag, high peak inspiratory flow rates may result in high peak airway pressure with subsequent stomach inflation; this may occur frequently when rescuers without daily experience in bag-valve-mask ventilation need to perform advanced airway management. The purpose of this study was to assess the effects of a newly developed self-inflating bag (mouth-to-bag resuscitator; Ambu, Glostrup, Denmark) that limits peak inspiratory flow. A bench model simulating a patient with an unintubated airway was used, consisting of a face mask, manikin head, training lung (lung compliance, 100 ml/0.098 kPa (100 ml/cm H(2)O)); airway resistance, 0.39 kPa/l per second (4 cm H(2)O/l/s), oesophagus (LESP, 1.96 kPa (20 cm H(2)O)) and simulated stomach. Twenty nurses were randomised to ventilate the manikin for 1 min (respiratory rate: 12 per minute) with either a standard self-inflating bag or the mouth-to-bag resuscitator, which requires the rescuer to blow up a single-use balloon inside the self-inflating bag, which in turns displaces air towards the patient. When supplemental oxygen is added, ventilation with up to 100% oxygen may be obtained, since expired air is only used as the driving gas. The mouth-to-bag resuscitator therefore allows two instead of one hand sealing the mask on the patient's face. The volunteers were blinded to the experimental design of the model until completion of the experimental protocol. The mouth-to-bag resuscitator versus standard self-inflating bag resulted in significantly (P<0.05) higher mean+/-S.D. mask tidal volumes (1048+/-161 vs. 785+/-174 ml) and lung tidal volumes (911+/-148 vs. 678+/-157 ml), longer inspiratory times (1.7+/-0.4 vs. 1.4+/-0.4 s), but significantly lower peak inspiratory flow rates (50+/-9 vs. 62+/-13 l/min) and mask leakage (10+/-4 vs. 15+/-9%); peak inspiratory pressure (17+/-2 vs. 17+/-2 cm H(2)O) and stomach tidal volumes (16+/-30 vs. 18+/-35 ml) were comparable. In conclusion, employing the mouth-to-bag resuscitator during simulated ventilation of an unintubated patient in respiratory arrest significantly decreased inspiratory flow rate and improved lung tidal volumes, while decreasing mask leakage.

Cardiopulmonary Resuscitation↗
PubMed2003

Experience with ketamine and sodium pentobarbital as anesthetics in a rat model of cardiac arrest and resuscitation.

We review 7 years experience with the chest compression model of cardiac arrest and resuscitation, comparing two different anesthetics. Ketamine stimulates cardiac function and only mildly depresses respiration; of the two it provides easier resuscitation. However, ketamine severely depresses brain protein synthesis; in studies using this measure ketamine is unsuitable and another agent must be used. Sodium pentobarbital mildly depresses brain protein synthesis, but depresses both cardiac and respiratory function, making resuscitation more difficult. Use of alternate chest/abdominal pumping (Babbs resuscitation technique), with judicious use of intra-cardiac epinephrine (adrenaline), made resuscitation reliable under sodium pentobarbital as well.

Anesthetics, Dissociative↗
PubMed2003

Pre-printed 'do not attempt resuscitation' forms improve documentation?

OBJECTIVE: Do not-attempt-resuscitate orders are fundamental for allowing patients to die peacefully without inappropriate resuscitation attempts. Once the decision has been made it is imperative to record this information accurately. However, during a related research projected we noted that documentation was poor and we thought that the introduction of a pre-printed Do Not Attempt Resuscitation (DNAR) form would improve the documentation process. DESIGN: Two sets of identical research questions were applied retrospectively, 12-months apart, to notes of adult patients (>18 years) who had died during a hospital admission without under-going a resuscitation attempt. Between the first and the second audit, a new resuscitation policy that incorporated a pre-printed DNAR form was introduced into our hospital. RESULTS: A pre-printed DNAR form improved documentation when measured against; clarity of DNAR order (P=0.05), date decision was made/implementation (P=0.014), presence of clinician's signature (P=0.001), identification of the senior clinician making the decision (P< or =0.001) and justification for the DNAR decision (P< or =0.001). However, the pre-printed form made little improvement in encouraging patient involvement in the DNAR decision-making process (P=0.348). CONCLUSION: A pre-printed DNAR form can improve documentation significantly but it has little effect in encouraging patient involvement in the decision-making process.

Adolescent↗
PubMed1996

Predicting in-hospital mortality during cardiopulmonary resuscitation.

On the average, 10-15% of patients who undergo cardiopulmonary resuscitation (CPR) following a cardiopulmonary arrest in the hospital environment will survive to be discharged. The purpose of this study was to determine objective factors influencing patient outcome after CPR to determine who should be resuscitated and when to end CPR efforts. The records of 266 patients who underwent in-hospital CPR over a 3-year period were retrospectively analyzed with regard to age, gender, co-morbid conditions, setting of arrest, duration of resuscitation, initial pH and PO2 during resuscitation, and outcome of resuscitative efforts. Twenty-four (9%) patients survived to be discharged from hospital. Eighty-seven (33%) patients arrested in the intensive care unit, 77 (29%) on the ward, 91 (34%) in the emergency room, six (2%) in the cardiac catheterization laboratory and five (2%) in the operating room. There was no significant difference in survival based on location of arrest. Factors associated with a poor prognosis included age greater than 60, co-morbid disease (i.e. pneumonia, sepsis, renal failure, heart disease, etc.), an initial PO2 < 50 mmHg and CPR efforts extending beyond 10 min. Based on this data, guidelines regarding initiation and termination of CPR should be instituted in light of poor outcome in patients over 60 years of age with co-morbid conditions, specifically after 10 min of CPR.

Age Factors↗