Cardiac arrest: a clinical prediction guide could help identify patients unlikely to survive to discharge

Clinical bottom line (level 1b)

  1. Few patients survive to discharge who have an unwitnessed cardiac arrest, an initial rhythm other than VT or VF, and no pulse regained within 10 minutes.
van Walraven et al: Journal of the American Medical Association 2001; 285 : 1602-1606
Expires October 2003

The study

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

Setting: university hospital, Canada

2181 patients (aged mean 65, 53% male) with a pulseless cardiac arrest

Excluded if
  • resuscitation performed in neontal intensive care unit or operating room
  • aged < 16
  • initial rhythm other than pulselss VT, VF, or pulseless electrical activity
  • no chest compressions performed
  • information for decision aid missing
  • time to initial chest compressions longer than 15 minutes
  • cardiac arrest outside hospital

    All patients were resuscitated using standard ACLS protocols.


    Outcomes studied:
  • discharged alive from hospital
  • discharge from hospital if any predictors present
  • discharge from hospital if no predictors present
    • Patients were ranked for survival using a clinical prediction rule: some chance of survival to discharge if
      • arrest witnessed (or on a cardiac monitor)
      • initial cardiac arrest rhythm VT or VT
      • pulse regained during the first 10 minutes

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    discharged alive from hospital ? 327/2181 15%
    (13% to 16%)
    discharge from hospital if any predictors present ? 324/1912 17%
    (15% to 19%)
    discharge from hospital if no predictors present ? 3/272 1.1%
    (0.0% to 2.4%)

    • decision rule: LR+ 1.16 (95% CI: 1.13 to 1.18)
    • LR - 0.064 (95% CI: 0.012 to 0.20)

    Comments

    1. 12% of patients were classified as unlikely to survive by the rule.

    Citation

    1. van Walraven C, Forster AJ, Parish DC, et al: validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations. Journal of the American Medical Association 2001; 285 : 1602-1606
    Search Terms: hand-search
    Contributor: Chris Ball, October 2001
    Reviewer: Clare Wotton

    Clinical Question.
    Patient cardiac arrest in hospital
    Intervention or Exposure clinical prediction guide
    Outcome death

The evidence

outcome time to outcome number of patients/total number %
(95% CI)
discharged alive from hospital ? 327/2181 15%
(13% to 16%)
discharge from hospital if any predictors present ? 324/1912 17%
(15% to 19%)
discharge from hospital if no predictors present ? 3/272 1.1%
(0.0% to 2.4%)

  • decision rule: LR+ 1.16 (95% CI: 1.13 to 1.18)
  • LR - 0.064 (95% CI: 0.012 to 0.20)

Comments

  1. 12% of patients were classified as unlikely to survive by the rule.

Citation

  1. van Walraven C, Forster AJ, Parish DC, et al: validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations. Journal of the American Medical Association 2001; 285 : 1602-1606
Search Terms: hand-search
Contributor: Chris Ball, October 2001
Reviewer: Clare Wotton

Clinical Question.
Patient cardiac arrest in hospital
Intervention or Exposure clinical prediction guide
Outcome death