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Resuscitation: when is enough, enough?

R J Hamill1

  • 1University of Virginia, Charlottesville, VA, USA.

Respiratory Care
|May 1, 1995
PubMed
Summary
This summary is machine-generated.

Cardiopulmonary resuscitation (CPR) has a low survival rate to hospital discharge, with many survivors experiencing neurological deficits. Prognostic factors like age, comorbidities, and time to defibrillation significantly impact outcomes, necessitating individualized patient assessment.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Critical Care Medicine

Background:

  • Cardiopulmonary arrest (CPA) resuscitation yields limited long-term survival, with a significant portion of survivors experiencing neurological impairments.
  • Identifying reliable prognostic indicators is crucial for optimizing the application of cardiopulmonary resuscitation (CPR).

Purpose of the Study:

  • To review and synthesize existing data on prognostic variables influencing outcomes after cardiopulmonary arrest and resuscitation.
  • To inform clinical decision-making regarding the judicious use of CPR based on patient-specific risk factors.

Main Methods:

  • Review of studies identifying factors associated with poor outcomes following CPA and CPR.
  • Analysis of variables including patient demographics, comorbidities, time to intervention, and post-arrest neurological status.

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Main Results:

  • Survival to discharge after CPA is approximately 15%, with one-third of survivors having neurological deficits.
  • Factors predicting poor outcomes include advanced age (often due to comorbidities), sepsis, AIDS, renal failure, cancer, and central nervous system disease.
  • Delayed defibrillation (>6 minutes), prolonged resuscitation (>15 minutes), low exhaled CO2, asystole/EMD as initial rhythm, and recurrent arrest are associated with >95% mortality.
  • Post-arrest neurological status, particularly unresponsiveness at 48 hours (5% full recovery) and absence of spontaneous respiration in out-of-hospital arrests, are strong negative prognostic indicators.

Conclusions:

  • While acute response to resuscitation occurs in nearly half of patients, most succumb within days.
  • Individualized assessment of risk factors is essential for determining CPR benefit.
  • Prognostic value of neurological status increases significantly after 48 hours post-arrest.