Cardiac Resuscitation And Outcomes

There are an estimated 750,000 sudden deaths in the United States annually. The outcome of resuscitative efforts for victims of cardiac arrest is uniformly poor, but varies, dependent on a variety of factors. The most important factor determining outcome is the time elapsed since arrest ("downtime"). One study showed a 27 percent resuscitation rate for patients who received advanced cardiac life support (ACLS) within 8 min of arrest, and a dismal outcome if more than 20 min elapses. 1 Improved outcomes have been demonstrated for witnessed arrests, who received early cardiopulmonary resuscitation (CPR) and advanced life support (ALS). Another important prognostic factor is the presenting rhythm. Previous studies have demonstrated improved survival rates for patients with presenting rhythms of ventricular fibrillation or ventricular tachycardia, and reduced survival rates for patients with asystole or pulseless electrical activity. The underlying medical condition of the patient is another important factor affecting outcome.

A potentially poor response to resuscitation can be expected for patients with metastatic disease, acute cerebrovascular accident, sepsis, renal failure, or pneumonia. Failure to respond to prehospital ALS protocols leads to a survival rate of less than 2 percent. The age of the patient also affects predicted survival rate, with a 0 percent survival rate for unwitnessed arrests of elderly patients 2 and for long-term care patients.3 Overall survival of victims of cardiac arrests, to hospital discharge, has been estimated to be between 0 and 16 percent.

Based on such data, several authors have suggested proposed criteria for withholding resuscitative efforts for patients in certain clinical settings with low likelihood of successful resuscitation (e.g., apneic, pulseless for longer than 10 min prior to Emergency Medical Service arrival, no response to ACLS, and preexisting terminal disease).4,5 Knowledge of data regarding resuscitation outcomes in various clinical settings is crucial when making evidence-based decisions regarding the risks and benefits of attempting cardiopulmonary resuscitation and the duration of the resuscitation attempt.

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