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Survival after cardiac arrest in hospital
Insights
This study of 1063 cardiac arrests found that while initial resuscitation is often unsuccessful, survival is possible, especially for cardiac disease and drug overdose patients. Long-term survival after hospital discharge was also encouraging.
Area of Science:
- Cardiology
- Emergency Medicine
- Hospital Management
Background:
- Cardiac arrest management is critical in district general hospitals.
- Understanding outcomes of resuscitation efforts is essential for improving patient care.
- A comprehensive review of a decade of cardiac arrest data provides valuable insights.
Purpose of the Study:
- To analyze the outcomes of cardiac arrests over a 10-year period in a district general hospital.
- To identify factors influencing resuscitation success and patient survival.
- To evaluate long-term survival and functional capacity after hospital discharge.
Main Methods:
- Retrospective review of 1063 cardiac arrest cases over 10 years.
- Exclusion of coronary and intensive care units to focus on general hospital areas.
- Analysis of initial resuscitation success, in-hospital mortality, discharge survival, and long-term outcomes.
Main Results:
- Initial resuscitation was unsuccessful in 67.5% of cases.
- 8.7% of patients were discharged alive, with a subsequent annual mortality of approximately 7% for the first five years post-discharge.
- Survival probability was higher for primary cardiac disease (11.8%), drug overdose (22.2%), and anesthesia-related arrests (20.0%).
- Resuscitation success rates were higher in the accident and emergency department (7.9%) compared to wards (2.1%), largely due to myocardial infarction cases.
- Survival rates were independent of patient age within diagnostic categories.
Conclusions:
- While cardiac arrest survival rates in general hospital settings are modest, a significant proportion of patients can be discharged with good long-term outcomes.
- Early identification of reversible causes and prompt resuscitation in appropriate departments like the accident and emergency department can improve survival.
- Age is not a significant factor in survival rates within specific diagnostic categories, highlighting the importance of timely and effective interventions for all patients.
Abstract:
A 10-year experience of cardiac arrests in a district general hospital is reviewed. 1063 arrests in the general areas of the hospital were studied, excluding the coronary and intensive care units. In 718 (67-5%) initial resuscitation was unsuccessful; in 252 (23-7%) the patient died later in hospital, 93 patients (8-7%) were discharged alive. After discharge from hospital there was a progressive annual mortality of about 7% for the first five years, but thereafter no patient died. Significant incapacity after discharge was also unusual. The probability of successful resuscitation was greater in patients with primary cardiac disease (11-8% survival), drug overdose (22-2% survival), or undergoing anaesthesia (20-0% survival). The success-rate was significantly greater in the accident and emergency department (7-9%) than on the wards (2-1%), but this difference was due entirely to the more successful resuscitation of patients with myocardial infarction in the accident and emergency department. Within each diagnostic category the survival-rate was independent of the age of the patient. Prolonged survival after resuscitation but ending in death before discharge was unusual.