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Abstract
Background: Survival outcomes after cardiac or respiratory arrest occurring outside of in - tensive care units (ICUs) has been well de - scribed. We investigated survival outcomes of adults whose arrest occurred in ICUs and de - termined predictors of decreased survival.
Methods: We reviewed all records of adults who experienced cardiac or respiratory arrest from Jan. 1, 2000, to Apr. 30, 2005, in ICUs at four hospitals serving Edmonton, Alberta. We evaluated patient and clinical characteristics, as well as survival outcomes during a five-year follow-up period. We determined risk factors for immediate (within 24 hours) and later death.
Results: Of the 517 patients included in the study, 59.6% were able to be resuscitated, 30.4% survived to discharge from ICU, 26.9% survived to discharge from hospital, 24.3% survived to one year, and 15.9% survived to five years. Pulseless electrical activity or asystole was the most common rhythm (45.8% of the arrests). Survival was lowest among pa - tients with an arrest due to pulseless electrical activity or asystole: only 10.6% survived to one year, compared with 36.3% who had other arrest rhythms (p < 0.001). Independent predictors of decreased later survival (eight months or more after arrest) were in - creasing age (ad justed hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03-1.09) and longer duration of cardiopulmonary resuscitation (CPR) (ad justed HR 1.38, 95% CI 1.03- 1.83, per additional logarithm of a min ute of CPR).
Interpretation: Our study showed no major im provement in survival following cardiac arrest with pulseless electrical activity or asystole as the presenting rhythm in the ICU de - spite many ad vances in critical care over the previous two decades. The independent predictors of death within 24 hours after arrest in an ICU were sex, the presenting rhythm and the duration of CPR. Predictors of later death (eight months or more after arrest) were age and duration of CPR.
Cardiac arrest remains a major clinical and public health problem.1 Studies of cardiac arrest in volving patients admitted to non-critical care beds showed that survival has not improved despite 40 years of medical ad - vances.2?4 Outside of critical care units, survival was substantially lower for nonwitnessed arrests than for witnessed arrests; for cardiac than for respiratory...