Predictors of Survival After Cardiac Arrest in ICU Identified

Lower survival for those suffering an arrest due to pulseless electrical activity than other rhythms

MONDAY, Aug. 15 (HealthDay News) -- Independent predictors of survival following cardiac arrest which occurs in the intensive care unit (ICU) include the presenting rhythm, age, and duration of cardiopulmonary resuscitation (CPR), according to a study published online Aug. 15 in CMAJ, the Journal of the Canadian Medical Association.

Demetrios J. Kutsogiannis, M.D., M.H.S., from the University of Alberta in Edmonton, Canada, and colleagues examined the survival outcomes of 517 adults whose cardiac arrest occurred in an ICU between January 2000 and April 2005, and determined predictors of decreased survival. Data were collected from four hospitals and assessed for patient and clinical characteristics and survival outcomes. Risk factors for immediate (within 24 hours) and later death (eight months or more after arrest) were determined. Participants were followed up for five years.

The investigators found that resuscitation was possible in 59.6 percent of the patients. A total of 30.4 percent of patients survived to discharge from ICU, and 26.9 percent to discharge from hospital, while 24.3 and 15.9 percent of the patients survived to one and five years, respectively. The most common arrest rhythm was pulseless electrical activity or asystole, and occurred in 45.8 percent of arrests. Compared to other arrest rhythms, asystole was associated with lowest survival (one year survival: 36.3 versus 10.6 percent). Increasing age (adjusted hazard ratio [HR], 1.06) and longer duration of CPR (HR, 1.38, per additional logarithm of a minute of CPR) were significant, independent predictors of decreased later survival.

"Although overall survival among ICU patients may have greatly improved, survival among those experiencing cardiac arrest in the ICU, particularly arrest due to pulseless electrical activity or asystole, remained comparatively poor," the authors write.

Two of the study authors disclosed financial ties to medical device, technology, and pharmaceutical industries.

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