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Cardiopulmonary resuscitation among mechanically ventilated patients

Ali Al-Alwan| William J. Ehlenbach| Prema R. Menon| Michael P. Young| Renee D. Stapleton
Original
Volume 40, Issue 4 / April , 2014

Pages 556 - 563

Abstract

Purpose

To evaluate the outcomes, including long-term survival, after cardiopulmonary resuscitation (CPR) in mechanically ventilated patients.

Methods

We analyzed Medicare data from 1994 to 2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated [defined by ICD-9 procedure code for intubation (96.04) or mechanical ventilation (96.7x) one or more days prior to procedure code for CPR (99.60 or 99.63)].

Results

We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4 % [95 % confidence interval (CI) 18.3–18.5 %]. Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1 % (95 % CI 9.8–10.4 %), compared to 19.2 % (95 % CI 19.1–19.3 %) in non-ventilated patients (p < 0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52 % lower odds of survival (OR 0.48, 95 % CI 0.46–0.49, p < 0.001). Median long-term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95 % CI 5.3–6.8 months), compared to 19.0 months (95 % CI 18.6–19.5 months) among the non-ventilated survivors (p < 0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1 % were alive at 1 year.

Conclusions

Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.

Keywords

References

  1. American Heart association (2013) About cardiopulmonary resuscitation (CPR). In: highlights of the history of cardiopulmonary resuscitation (CPR). American Heart association. DIALOG. http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/History-of-CPR_UCM_307549_Article.jsp. Accessed 19 August 2013
  2. Kouwenhoven WB, Jude JR, Knickerbocker GG (1960) Closed-chest cardiac massage. JAMA 173:94–97
    • View reference on publisher's website
  3. Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A (2013) Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med 39:1972–1980. doi:10.1007/s00134-013-3043-4
  4. Begg CB, Riedel ER, Bach PB et al (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346:1138–1144
    • View reference on PubMed
    • View reference on publisher's website
  5. Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474
    • View reference on PubMed
    • View reference on publisher's website
  6. Sharma G, Freeman J, Zhang D, Goodwin JS (2009) Continuity of care and intensive care unit use at the end of life. Arch Intern Med 169:81–86
    • View reference on PubMed
    • View reference on publisher's website
  7. Arday SL, Arday DR, Monroe S, Zhang J (2000) HCFA’s racial and ethnic data: current accuracy and recent improvements. Health Care Financ Rev 21:107–116
    • View reference on PubMed
  8. Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139
    • View reference on PubMed
    • View reference on publisher's website
  9. Morrill R, Cromartie J, Hart G (1999) Metropolitan, urban, and rural commuting areas: toward a better depiction of the United States settlement system. Urban Geogr 20:727–748
    • View reference on publisher's website
  10. Tian J, Kaufman DA, Zarich S et al (2010) Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 182:501–506
    • View reference on PubMed
    • View reference on publisher's website
  11. Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG (2011) Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ 183:1589–1595
    • View reference on PubMed
    • View reference on publisher's website
  12. Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245
  13. Peberdy MA, Kaye W, Ornato JP et al (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58:297–308
    • View reference on PubMed
    • View reference on publisher's website
  14. Sandroni C, Ferro G, Santangelo S et al (2004) In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation 62:291–297
    • View reference on PubMed
    • View reference on publisher's website
  15. Breslow MJ, Badawi O (2012) Severity scoring in the critically ill: part 1-interpretation and accuracy of outcomes prediction scoring systems. Chest 141:245–252
    • View reference on PubMed
    • View reference on publisher's website
  16. Daly BJ, Douglas SL, Gordon NH et al (2009) Composite outcomes of chronically critically ill patients 4 months after hospital discharge. Am J Crit Care 18:456–464
    • View reference on PubMed
    • View reference on publisher's website
  17. Lannon R, O’Keeffe ST (2010) Cardiopulmonary resuscitation in older people—a review. Rev Clin Gerontol 20:20–29
    • View reference on publisher's website
  18. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, American Heart Association Get with the Guidelines-Resuscitation Investigators (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367:1912–1920
    • View reference on PubMed
    • View reference on publisher's website
  19. Larkin GL, Copes WS, Nathanson BH, Kaye W (2010) Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation. Resuscitation 81:302–311
    • View reference on PubMed
    • View reference on publisher's website
  20. Ebell MH, Becker LA, Barry HC, Hagen M (1998) Survival after in-hospital cardiopulmonary resuscitation. A meta analysis. J Gen Intern Med 13:805–816
    • View reference on PubMed
    • View reference on publisher's website
  21. Watkins LO (2004) Epidemiology and burden of cardiovascular disease. Clin Cardiol 27(6 Suppl 3):III 2–III 6
    • View reference on publisher's website
  22. Ebell MH, Smith M, Kruse JA, Drader-Wilcox J, Novak J (1995) Effect of race on survival following in-hospital cardiopulmonary resuscitation. J Fam Pract 40:571–577
    • View reference on PubMed
  23. Virnig BA, Lurie N, Huang Z, Musgrave D, McBean AM, Dowd B (2002) Racial variation in quality of care among Medicare + Choice enrollees. Health Aff (Millwood) 21:224–230
    • View reference on publisher's website
  24. Galea S, Blaney S, Nandi A et al (2007) Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol 166:534–543
    • View reference on PubMed
    • View reference on publisher's website
  25. Barnato AE, Chang CC, Saynina O, Garber AM (2007) Influence of race on inpatient treatment intensity at the end of life. J Gen Intern Med 22:338–345
    • View reference on PubMed
    • View reference on publisher's website
  26. Shepardson LB, Gordon HS, Ibrahim SA, Harper DL, Rosenthal GE (1999) Racial variation in the use of do-not-resuscitate orders. J Gen Intern Med 14:15–20
    • View reference on PubMed
    • View reference on publisher's website
  27. Wenger NS, Pearson ML, Desmond KA (1995) Epidemiology of do-not-resuscitate orders: disparity by age, diagnosis, gender, race, and functional impairment. Arch Intern Med 155:2056–2062
    • View reference on PubMed
    • View reference on publisher's website
  28. Levy CR, Fish R, Kramer A (2005) Do-not-resuscitate and do-not-hospitalize directives of persons admitted to skilled nursing facilities under the Medicare benefit. J Am Geriatr Soc 53:2060–2068
    • View reference on PubMed
    • View reference on publisher's website
  29. Rich SE, Gruber-Baldini AL, Quinn CC, Zimmerman SI (2009) Discussion as a factor in racial disparity in advance directive completion at nursing home admission. J Am Geriatr Soc 57:146–152
    • View reference on PubMed
    • View reference on publisher's website
  30. Skogvoll E, Isern E, Sangolt GK, Gisvold SE (1999) In-hospital cardiopulmonary resuscitation. 5 years’ incidence and survival according to the Utstein template. Acta Anaesthesiol Scand 43:177–184
    • View reference on PubMed
    • View reference on publisher's website
  31. Nadkarni VM, Larkin GL, Peberdy MA et al (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295:50–57
    • View reference on PubMed
    • View reference on publisher's website
  32. Mayr VD, Dünser MW, Greil V et al (2006) Causes of death and determinants of outcome in critically ill patients. Crit Care 10:R154. doi:10.1186/cc5086
    • View reference on PubMed
    • View reference on publisher's website
  33. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
    • View reference on PubMed
    • View reference on publisher's website
  34. Wallmuller C, Meron G, Kurkciyan I, Schober A, Stratil P, Sterz F (2012) Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation 83:1206–1211
    • View reference on PubMed
    • View reference on publisher's website
  35. Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD (2009) Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 361:22–31
    • View reference on PubMed
    • View reference on publisher's website
  36. Saklayen M, Liss H, Markert R (1995) In-hospital cardiopulmonary resuscitation: survival in 1 hospital and literature review. Medicine (Baltimore) 74:163–175
    • View reference on publisher's website
  37. Cohn AC, Wilson WM, Yan B et al (2004) Analysis of clinical outcomes following in-hospital adult cardiac arrest. Intern Med J 34:398–402
    • View reference on PubMed
    • View reference on publisher's website
  38. Zoch TW, Desbiens NA, DeStefano F, Stueland DT, Layde PM (2000) Short- and long-term survival after cardiopulmonary resuscitation. Arch Intern Med 160:1969–1973
    • View reference on PubMed
    • View reference on publisher's website

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