Cardiac arrest: a previous stroke, renal failure and current congestive heart failure increased the risk of dying following an arrest

Clinical bottom line (level 1b)

  1. A fifth of patients who had a cardiac arrest in hospital were discharged alive.
  2. Patients were at increased risk of dying following an in-hospital cardiac arrest if they
    • had a stroke before admission
    • had renal failure before admission
    • had congestive heart failure during admission
    • were aged 70 or more
  3. Patients were less likely to die following an in-hospital cardiac arrest if they had
    • ventricular dysrhythmias on admission
    • angina before admission
de Vos et al: Archives of Internal Medicine 1999; 159: 845-850
Expires October 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: University hospital, The Netherlands

553 patients (aged range 18 to 98 years; mean 68, 57% male) all consecutive patients with an in-hospital cardiac arrest and an attempted resuscitation by the resuscitation team.

Excluded if
  • medical records could not be traced
  • <18 years old
  • out-of-hospital cardiac arrest
  • a second subsequent cardiac arrest during the same hospital admission
  • patient dead on arrival



    • Factors studied:
  • main morbidity before and during hospital admission, and new morbidity during hospital admission
  • stroke before admission
  • renal failure before admission
  • congestive heart failure during admission
  • aged 70 or more
  • angina before admission
  • ventricular dysrhythmia on admission


    • Advanced life support provided by a 24-hour resuscitation team (anaesthesiology resident, cardiology resident and anaesthesiology nurse), according to American Heart Association and the European Resuscitation Council guidelines.

    Multivariate analysis logistic regression used to adjust for confounding factors.

    100% followed for length of hospital stay
    Outcomes studied:
  • survival

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    survival length of hospital stay 120/553 22%
    (18% to 25%)    		 5
    (4 to 5)

    prognostic factor for
    survival     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    stroke before admission ? 115/499
    (23.0%)     		0.3
    (0.1 to 0.7)     		7
    (5 to 17)
    renal failure before admission ? 116/507
    (22.9%)     		0.3
    (0.1 to 0.8)     		7
    (5 to 27)
    congestive heart failure during admission ? 112/494
    (22.7%)     		0.4
    (0.2 to 0.9)     		8
    (6 to 56)
    aged 70 or more ? 73/287
    (25.4%)     		0.6
    (0.4 to 0.9)     		13
    (8 to 56)
    angina before admission ? 76/407
    (18.7%)     		2.1
    (1.3 to 3.3)     		-7
    (-23 to -4)
    ventricular dysrhythmia on admission ? 106/533
    (19.9%)     		11.0
    (4.1 to 33.7)     		-2
    (-3 to -1)

    Comments

    1. This study is not very helpful, since it only looks at prognostic factors in patients who have had a cardiac arrest, and had resuscitation performed. More useful is to know which markers in any admitted patient predicts a poor outcome from CPR before resuscitation is attempted.
    2. Other resuscitation prediction rules have not been found to be useful when validated in another set of patients.

    Citation

    1. de Vos R, Koster RW, de Haan RJ, et al: In-hospital cardiopulmonary resuscitation: Pre arrest morbidity and outcome. Archives of Internal Medicine 1999; 159: 845-850
    Contributor: Clare Wotton & Chris Ball, October 1999
    Reviewer: Dwight Peretz

    Clinical Question.
    Patient in-hospital CPR
    Intervention or Exposure
    Comparison pre arrest morbidity
    Outcome outcome