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In-hospital CPR survival unchanged over past 2 decades
2 July 2009
MedWire News: Survival after in-hospital cardiopulmonary resuscitation (CPR) has not changed substantially over the past 2 decades, US research suggests.
Overall survival stayed at around 18% from 1992 through to 2005, according to the study in the New England Journal of Medicine by William Ehlenbach (University of Washington, Seattle) and colleagues.
Among “numerous possible explanations” for the lack of improvement, the authors speculate that such a static survival rate could occur if improvements in CPR over time have been offset by changes in the severity of illness, underlying cause, or initial arrest rhythm among patients with cardiac arrest.
Changes in delivery of CPR that have contributed to improved survival in the out-of-hospital setting have no bearing on outcomes in an in-hospital setting, the researchers note. It remains unclear whether other innovations have impacted on in-hospital survival after CPR.
To investigate further, Ehlenbach’s team studied data for Medicare patients aged 65 years or older.
They report that 433,985 beneficiaries underwent CPR in US hospitals between 1992 and 2005. The overall incidence of CPR was 2.73 events per 1000 admissions, and the overall survival rate after CPR was 18.3%.
CPR was performed more often on Black and other non-White than White patients (4.35 and 3.85 vs 2.53 deliveries per 1000 admissions, respectively), but survival was lower among Black and other non-White than White patients (14.3% and 15.9% vs 19.2%, respectively).
Survival was also lower among men than women, with older age, with increasing number of co-existing illnesses, and among patients admitted from a skilled nursing facility and those receiving care in a metropolitan or a teaching hospital.
Of note, in multivariable analysis, Black patients were 30% less likely to survive than their White counterparts after adjustment for patient factors, but this was slightly attenuated to a 24% lower risk after further adjusting for individual hospital. This suggests that the difference in survival may be partly due to Black patients being more likely to be treated in hospitals with decreased odds of survival after CPR irrespective of race, the authors comment.
Ehlenbach and team also found that the proportion of patients who died in hospital after having previously undergone in-hospital CPR actually increased over the study period, from 3.8% in 1992 to 5.2% in 2005 (p<0.001). This was “of significant concern,” they say, “during a time of more education and awareness about the limits of CPR in patients with advanced chronic illness and life-threatening acute disease.”
The researchers conclude: “This study provides information useful to older patients and their clinicians in their decision about whether to choose to be resuscitated, since the proportion of elderly patients who choose resuscitation is directly related to the probability of survival that is presented to these patients.
“Our findings also provide a stimulus to understand the association between race and survival, with the goals of not only eliminating racial disparities in the quality of medical care but also understanding factors associated with the incidence of CPR and the rate of survival after CPR for patients of all races.”
