Cardiac arrest: PAR, PAM and APACHE III scores did not predict the outcome of in-hospital cardiac arrest

Clinical bottom line (level 1b)

  1. 5% of patients who had an in-hospital cardiac arrest survived to discharge.
  2. The Pre-Arrest Morbidity (PAM) score, the Prognosis after Resuscitation (PAR) score and the APACHE III score did not usefully predict the outcome of in-hospital cardiopulmonary resuscitation.
Ebell et al: Medical Decision Making 1997; 17 (2): 171-177
Expires November 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: 3 acute hospitals, USA

656 patients (aged mean 63, 57% female) admitted to hospital who underwent resuscitation for a cardiac arrest during their stay

Excluded if
  • use of chest compressions, artificial ventilation or rescue breathing and cardiac medications not documented
  • resuscitated in the operating room, or emergency department only



    • Factors studied:
  • clinical features in first 24 hours; 3 clinical prediction rules (PAM, PAR and APACHE III)




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

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    survival to discharge length of hospital stay 35/656 5.3%
    (3.6% to 7.1%)    		 19
    (14 to 28)

    • None of the 3 clinical prediction rules usefully predicted the outcome of an in-hospital cardiac arrest.

    Citation

    1. Ebell MH, Kruse JA, Smith M, et al: failure of three decision rules to predict the outcome of in-hospital cardiopulmonary resuscitation. Medical Decision Making 1997; 17 (2): 171-177
    Search Terms: arrest in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Roy Poses

    Clinical Question.
    Patient in-hospital cardiac arrest
    Intervention or Exposure PAM, PAR and APACHE III scores
    Outcome predict outcome of CPR