Elsevier

Resuscitation

Volume 53, Issue 3, June 2002, Pages 265-270
Resuscitation

Factors influencing the outcomes after in-hospital resuscitation in Taiwan

https://doi.org/10.1016/S0300-9572(02)00024-2Get rights and content

Abstract

Background: The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. Materials and Methods: We studied the in-hospital resuscitation events in a tertiary medical center in Taipei city, Taiwan. All events and variables were recorded using the Utstein style for in-hospital resuscitation. We measured the influence of patients and event variables on the outcomes of return of spontaneous circulation (ROSC) and survival to discharge. Results: The rate of establishing a ROSC was 67% and the rate of survival to discharge was 17% in the studied population. The 1-year survival rate was 3.9%. Only 17% of the patients resuscitated had coronary artery disease. VT/VF was the initial rhythm in only 13.6% patients. Nearly half (49%) of the resuscitation attempts took place in emergency department (ED). Patients who were already intubated or had received mechanical ventilation before resuscitation had reduced chances of achieving ROSC. (P<0.05). Favorable prognostic factors of survival to discharge were shorter time intervals from patient collapse to arrival of the resuscitation team (69 vs. 154 s, P<0.05) and to confirmation of arrest (93 vs. 217 s, P<0.05). Conclusion: Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.

Introduction

Cardiopulmonary resuscitation (CPR) and advanced life support (ALS) have been used to improve outcome for in-hospital patients with cardiac and respiratory arrest. The characteristics of patients resuscitated in-hospital and the prognostic factors have been studied [1], [2], [3], [4], [5], [6]. However, these studies have been undertaken in different countries, different patient populations and different definitions of the variables in resuscitation. Some studies reveal that local demographics, causes of collapse and other factors may affect the outcome of resuscitation. The incidence of sudden cardiac death and ventricular dysrhythmias is low in oriental countries in pre-hospital resuscitation studies [7], [8], [9]. Prevalence of ischaemic heart disease is also low in the orient. The influence of different disease patterns in different areas on the results of in-hospital resuscitation has not been studied.

The initiation of resuscitation in patients with cardiac arrest in-hospital are not so straightforward compared to out of hospital cardiac arrest. Pre-existing diseases in in-hospital patients may predict worse a poor outcome. The physicians, patients and the family must consider whether to start CPR in such conditions. Factors, such as pre-arrest status, time to start resuscitation and the initial cardiac rhythm have been shown to be the predictors of survival following in-hospital resuscitation in previous studies [3], [10], [11]. Accurate identification could potentially reduce suffering got the patient and the family and health care costs [1]. However, the prognostic implication of some factors is not clear. ALCS interventions in place at the time of arrest, such as intravenous access, trachea intubation, mechanical ventilation, etc. may facilitate the resuscitation process. On the other hand, the fact that these interventions are in place may imply poor health before the event.

Differences in the definitions of variables could result in variation in reported results, including the return of spontaneous circulation (ROSC) and survival rate. The Utstein style recommendation for uniform reporting of in-hospital resuscitation is proposed to minimize diversity in various reports [12], [13]. In our study, we have used the in-hospital Utstein style to record associated factors and the outcome variables in a tertiary medical center in an oriental island country, Taiwan. We analyze the demographic characteristics of the patients and the possible event variables those may influence the outcomes.

Section snippets

Material and methods

The National Taiwan University Hospital is a 2000-bed tertiary medical center in Taipei City, Taiwan. In addition to the doctors and nurses on duty in the ward, there is a resuscitation team that is called whenever a patient collapses. The team includes doctors, well-trained nurses, and respiratory therapists, who perform their regular work in the ward or critical care unit and are able to go to the scene if called. We reviewed all the accessible charts and resuscitation records of patients who

Results

We collected 110 in-hospital resuscitation cases in the study period. All patients had received cardiac compression. Seven patients were excluded from the analysis due to insufficient baseline data and incomplete resuscitation records. A total of 103 patients were analyzed for the event variables and resuscitation results. The mean age was 66.8 years and 71% were men. Hypertension (33%) and diabetes mellitus (36%) were the two most common underlying diseases before resuscitation. The prevalence

Discussion

The lower rate of ROSC in patients with pre-collapse intubation or mechanical ventilation has some important implications. Functional status before arrest, as with a duration of arrest <5 min, is an important factor for the outcome after in-hospital resuscitation [10]. Pre-existing intubation or mechanical ventilation implicates an impaired airway with or without respiratory failure. It is known that patients with impaired vital functions are less likely to benefit from in-hospital

Acknowledgements

The study was supported by research grants from IFM 88-A004 and 89-M003, Institute of Forensic Medicine, Ministry of Justice, Taiwan.

Portuguese Abstract and Keywords
Contexto: Não é claro o efeito que podem ter no prognóstico algumas intervenções avançadas, estabelecidas antes da ocorrência da Paragem Cardio-Pulmonar. O padrões de prognóstico associados aos vários factores da reanimação intra-hospitalar também são influenciados pelo tipo de doença em área da ocorrência. Os autores estudaram os factores relacionados com o prognóstico num Paı́s oriental. Material e métodos: Estudámos a reanimação intra-hospitalar num centro

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Portuguese Abstract and Keywords
Contexto: Não é claro o efeito que podem ter no prognóstico algumas intervenções avançadas, estabelecidas antes da ocorrência da Paragem Cardio-Pulmonar. O padrões de prognóstico associados aos vários factores da reanimação intra-hospitalar também são influenciados pelo tipo de doença em área da ocorrência. Os autores estudaram os factores relacionados com o prognóstico num Paı́s oriental. Material e métodos: Estudámos a reanimação intra-hospitalar num centro médico terciário na cidade de Talpei, Taiwan. Foram registados todos os eventos e variáveis usando o modelo Utstein para a reanimação intra-hospitalar. Avaliamos a influência no prognóstico das variáveis relacionadas com os acontecimentos, com os doentes, com a Recuperação de Circulação Espontânea (ROSC) e com a sobrevivência à data da alta. Resultados: A taxa de restabelecimento da ROSC, na população estudada, foi 67% e a taxa de sobrevivência à data da alta foi 17%. A taxa de sobrevivência ao fim de um ano foi de 39%. Apenas 17% dos pacientes reanimados tinham doença arterial coronária. Só em 13.6% dos doentes é que o ritmo inicial da paragem, identificado, foi VT/VF. Quase metade (49%) das tentativas de reanimação foram feitas no Departamento de Emergência (DE). Os doentes que já tinham sido entubados ou que tinham sido ventilados mecanicamente antes da reanimação tinham menos probabilidade de ROSC (p<0.05). Foram identificados como factores de prognóstico favorável para a sobrevivência à data da alta: intervalo curto do colapso á chegada da equipa de reanimação (69 vs 154 s, p< 0.05) e a confirmação da paragem (93 vs 27 s, p<0.05). Conclusão: Quando a entubação e a ventilação mecânica já tinham sido estabelecidas antes da paragem significa que existe subjacente uma doença crı́tica, o que reduz a possibilidade de ROSC. Intervalos curtos entre o colapso e a reanimação melhoram a probabilidade de sobrevivência à alta. O grande número de episódios de reanimação que ocorreram no DE, reflectindo a sobrecarga do DE, e a baixa frequência de doença arterial coronária pré-existente são únicos no nosso paı́s.
Palavras chave: Reanimação cardio-pulmonar; Entubação; Retorno de ventilação espontânea; Prognóstico
Spanish Abstract and Keywords
Antecedentes: No están claros los efectos de algunas intervenciones avanzadas ya establecidas en el paciente antes de iniciar reanimación cardiopulmonar, sobre el pronóstico del paro cardiorespiratorio intra hospitalario. Los resultados y patrones de varios factores de reanimación intrahospitalaria están también influenciados por diferentes patrones de enfermedades en diferentes áreas. Estudiamos los factores relacionados con el resultado en un paı́s oriental. Materiales y métodos: Estudiamos los eventos de reanimación intrahospitalaria en un centro médico de nivel terciario en la ciudad de Taipei, Taiwan. Todos los eventos y las variables fueron registrados usando el estilo Utstein para reanimación intrahospitalaria. Medimos la influencia de las variables de evento y de paciente sobre los resultados retorno a circulación espontánea (ROSC) y sobrevida al alta. Resultados: La tasa de ROSC establecido fue 67% y la tasa de sobrevida al alta fue 17% de la población estudiada. La sobrevida a 1 año fue 3.9%. Solamente el 17% de los pacientes resucitados tenı́an enfermedad de arterias coronarias. Casi la mitad (49%) de los intentos de resucitación tuvieron lugar en el departamento de emergencia (ED). Los pacientes que ya se encontraban intubados o que habı́an recibido ventilación mecánica tenı́an menor probabilidad de ROSC (P < 0.05). Factores pronósticos favorables para la sobrevida al alta fueron los intervalos de tiempo más cortos entre el colapso del paciente y la llegada del equipo de resucitación ( 69 vs. 154 s, P < 0.05) y entre el colapso y la confirmación del paro (93 vs. 217 s, P < 0.05). Conclusión: La presencia de intubación traqueal y ventilación mecánica establecida antes del paro implica una enfermedad subyacente crı́tica y reduce la probabilidad de ROSC. Intervalos mas cortos desde el colapso a la resucitación mejoran la probabilidad de sobrevida al alta. La alta proporción de eventos en el departamento de emergencia (ED) que refleja lo sobrecargado que está el ED, y la baja frecuencia de enfermedad coronaria pre-existente son sin igual en nuestro paı́s.
Palabras clave: Resucitación cardiopulmonar; Intubación; Retorno a circulación espontánea; Resultado

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