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Factors influencing outcome in patients with cardiac arrest in the ICU
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Cardiopulmonary resuscitation (CPR) survival in intensive care units (ICUs) depends on factors like normoxia and ventricular tachycardia/fibrillation. Early enteral nutrition and maintaining normoxia improve outcomes for patients surviving 24 hours post-CPR.
Area of Science:
- Critical Care Medicine
- Cardiology
- Emergency Medicine
Background:
- Long-term survival predictors after cardiopulmonary resuscitation (CPR) in intensive care unit (ICU) patients are not well-defined.
- Identifying pre-arrest, intra-arrest, and post-arrest factors is crucial for improving patient outcomes.
Purpose of the Study:
- To identify pre- and intra-arrest factors associated with 3-month survival after CPR in ICU patients.
- To identify post-arrest factors associated with long-term survival in patients who survived the initial 24 hours post-CPR.
Main Methods:
- Retrospective analysis of 131 ICU patients who underwent CPR between January 2009 and June 2010.
- Data categorized using the Utstein template for standardized reporting.
Main Results:
- Overall 3-month survival rate was 20.6%.
- Pre- and intra-arrest predictors of 3-month survival included lower APACHE II score, ventricular tachycardia/ventricular fibrillation (VT/VF), and normoxia during CPR.
- For patients surviving 24 hours, early enteral nutrition and post-arrest normoxia predicted 3-month survival.
Conclusions:
- Normoxia during CPR and the presence of VT/VF are significant predictors of long-term survival post-CPR in ICU patients.
- For survivors of the first 24 hours, initiating enteral nutrition within 48 hours and maintaining normoxia are associated with improved outcomes.
Background:
Post-arrest variables associated with long-term survival after cardiopulmonary resuscitation (CPR) in intensive care unit (ICU) patients remain unclear. This study was designed to identify pre- and intra-arrest factors associated with survival 3 months after CPR in ICU patients and to identify post-arrest factors associated with long-term survival in those who survived 24 h after CPR.
Methods:
A total of 131 ICU patients undergoing CPR from January 2009 to June 2010 were included. Data were retrospectively analysed and categorized based on the Utstein template.
Results:
The overall survival rate 3 months after CPR was 20.6%. Logistic regression analysis revealed that acute physiology and chronic health evaluation (APACHE) II score (odds ratio, 95% confidence interval, 0.87 [0.83-0.93]; P < 0.001), ventricular tachycardia/ventricular fibrillation (VT/VF, 5.55 [1.55-19.83]; P = 0.032), and normoxia during CPR (4.45 [1.34-14.71]; P = 0.045) were significant independent pre- and intra-arrest predictors of 3-month survival after CPR in ICU patients. Fifty-seven patients survived 24 h after CPR, and their 3-month survival rate was 47.4%. Early enteral nutrition (9.94 [1.96-50.43]; P = 0.030) and normoxia after return of spontaneous circulation (10.75 [2.03-55.56]; P = 0.030) were predictive of 3-month survival in patients who survived 24 h after CPR.
Conclusions:
Normoxia during CPR and VT/VF were predictors of long-term survival after CPR in ICU patients. In patients surviving 24 h after CPR, initiation of enteral nutrition within 48 h and maintenance of normoxia were associated with a positive outcome.
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