Outcome of cardiopulmonary resuscitation - Predictors of survival

Objective: To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Design: A cross-sectional study. Place and Duration of Study: Shifa International Hospital, Islamabad from January 2005 to December 2005. Patients and Methods: Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Results: Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-vaiue 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95%CI = 0.19-0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95%CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95%CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio 2.52, 95%CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95%CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95%CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95%CI = 0.85-0.96, p-value = 0.001), and total atropine does given during CPR (odds ratio = 0.68, 95%CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio = 8.69, 95%CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95%CI = 0.87-0.98, p-value = 0.01) were associated with survival at discharge from hospital. Conclusion: In-hospital cardiopulmonary arrest was associated with better clinical outcomes as compared to outside hospital arrest. Public education is needed to improve clinical outcomes in patients who need CPR outside hospital.