Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation

A meta-analysis

Mark H. Ebell, Anna M. Afonso

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Purpose: Our objective was to perform a systematic review of pre-arrest predictors of the outcome of in-hospital cardiopulmonary resuscitation (CPR) in adults. Methods: We searched PubMed for studies published since 1985 and bibliographies of previous meta-analyses. We included studies with predominantly adult patients, limited to in-hospital arrest, using an explicit definition of cardiopulmonary arrest and CPR and reporting survival to discharge by at least one pre-arrest variable. A total of 35 studieswere included in the final analysis. Inclusion criteria, design elements and results were abstracted in parallel by both investigators. Discrepancies were resolved by consensus. Results: The rate of survival to discharge was 17.5%; we found a trend towards increasing survival in more recent studies. Metastatic malignancy [odds ratio (OR) 3.9] or haematologic malignancy (OR 3.9), age over 70, 75 or 80 years (OR 1.5, 2.8 and 2.7, respectively), black race (OR 2.1), altered mental status (OR 2.2), dependency for activities of daily living (range OR 3.2-7.0 depending on specific activity), impaired renal function (OR 1.9), hypotension on admission (OR 1.8) and admission for pneumonia (OR 1.7), trauma (OR 1.7) or medical non-cardiac diagnosis (OR 2.2) were significantly associated with failure to survive to discharge; cardiovascular diagnoses and co-morbidities were associated with improved survival (range OR 0.23-0.53). Elevated CPR risk scores predicted failure to survive but have not been validated consistently in different populations. Conclusions: We identified several pre-arrest variables associated with failure to survive to discharge. This information should be shared with patients as part of a shared decision-making process regarding the use of do not resuscitate orders.

Original languageEnglish (US)
Pages (from-to)505-515
Number of pages11
JournalFamily Practice
Volume28
Issue number5
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Meta-Analysis
Odds Ratio
Survival
Resuscitation Orders
Bibliography
Hematologic Neoplasms
Activities of Daily Living
Heart Arrest
PubMed
Hypotension
Pneumonia
Consensus
Decision Making
Survival Rate
Research Personnel
Morbidity

Keywords

  • Ageing
  • Cardiology
  • Meta-analysis
  • Palliative care
  • Systematic review

ASJC Scopus subject areas

  • Family Practice

Cite this

Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation : A meta-analysis. / Ebell, Mark H.; Afonso, Anna M.

In: Family Practice, Vol. 28, No. 5, 01.10.2011, p. 505-515.

Research output: Contribution to journalArticle

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