Evaluation of inhospital cardiopulmonary resuscitation

Of 77 patients who received cardiopulmonary resuscitation (CPR) for an inhospital cardiac arrest from Jan. 1987 to Mar. 1988. 48(68%) survived the initial resuscitation, but only 11(16%) survived to leave hospital. A follow-up survey to Oct. 1988, of these 11 patients showed that one died within 11 months of discharge, but that others were all alive and living independently. The major cause of cardiopulmonary arrest was airway obstruction. Survival rates were lower if resuscitation efforts lasted more than 30 minutes or if the event occurred between midnight and 8:00 AM. Thirty of the 48 patients who were successfully resuscitated initially were transferred to the intensive care unit for prolonged cardiac life support. Of the patients who had underlying disease or severe neurologic impairment due to hypoxic encephalopathy, 19(63%) were dead within a few days or even hours after CPR. Therefore, we recommend (1) programs for routine CPR assessment (2) extension of CPR training for key personnel, especially ward staff working night shifts (3) assessment by CPR providers as to whether or not to continue or to give DNR (do-not-resuscitate) orders.