Cardiac arrest: following CPR a sixth left hospital alive

Clinical bottom line (level 2a)

  1. A sixth of patients who had a cardiac arrest who received cardiopulmonary resuscitation survived to leave hospital.
  2. Patients were more likely to leave hospital alive if they were
    • in VT or VF
    • aged <70
Schneider et al: Journal of the American Board of Family Practice 1993; 6: 91-101
Expires October 2003

The study

Systematic review of all published studies of
  • Patients: in-patients with a cardiac arrest
  • Intervention: cardiopulmonary resuscitation
  • Outcome: survival to discharge


    • Articles found in English using MEDLINE, 1966 to 1990 (search terms: 'cardiopulmonary resuscitation', 'resuscitation' and 'heart arrest' ) and manual searches of cited references in articles and previous reviews

    Selection criteria: see above
    Appraisal criteria: not given
    Articles excluded if: any of
    • patients mainly children
    • no information on survival to discharge
    • less than 5 patients


    98 studies involving 19955 patients
    No information on study heterogeneity.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    survival to discharge ? 2994/19955 15.0%
    (14.5% to 15.5%)    		 7
    (6 to 7)
    survival to discharge aged >70 ? 259/2097 12%
    (11% to 14%)    		 8
    (7 to 9)
    survival to discharge aged <70 ? 597/3692 16%
    (15% to 17%)    		 6
    (6 to 7)
    survival to discharge with a VF/VT arrest ? 346/1732 20%
    (18% to 22%)    		 5
    (5 to 6)
    survival to discharge with other rhythm ? 252/3248 7.76%
    (6.84% to 8.68%)    		 13
    (12 to 15)

    Comments

    1. Complications found on autopsy included rib fractures (32%), marrow emboli (11%), haemopericardium (5%) and liver (5% or spleen lacerations (5%).
    2. No information on other interventions patients might have received.
    3. The shorter the duration of the resuscitation meant a greater chance of survival to discharge.
    4. Patients with a dissecting aneurysm, sepsis, CNS disease, trauma, uraemia, cancer or PE had a low chance of survival (<7%)
    5. Patients with pneumonia, congestive heart failure, pulmonary oedema, COPD, coronary artery disease or myocardial infarction had moderate success rates (7% to 26%).
    6. Patients in shock had the best chance of survival (>26%).
    7. There has been little improvement in survival from cardiac arrest over the last 30 years.

    Citation

    1. Schneider AP, Nelson DJ, Brown DD: In-hospital cardiopulmonary resuscitation: a 30-year review. Journal of the American Board of Family Practice 1993; 6: 91-101
    Contributor: Chris Ball and Clare Wotton, October 1998
    Reviewer:

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure cardiopulmonary resuscitation
    Outcome survival