Influences of "do-not-resuscitate order" prohibition on CPR outcomes (original) (raw)
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Factors affecting outcome following cardiopulmonary resuscitation
Anaesthesia and intensive care, 1994
Many patients who receive cardiopulmonary resuscitation (CPR) for cardiac arrest do not survive to leave hospital. Factors associated with adverse outcomes include unwitnessed cardiac arrest in general wards, particularly at night, prolonged resuscitation, asystole, associated disorders (e.g. sepsis, malignancy, renal failure, and left ventricular dysfunction), absent pupillary responses, hypoxaemia, low PetCO2 during resuscitation, and severe acid base imbalance. Outside hospitals, cardiac arrests result in more favourable outcomes if they occur at work, and bystander CPR and early defibrillation are initiated. On admission to ICU, likely predictors of death or severe neurological disability include prolonged coma, impaired brainstem reflexes, and persistent convulsions. Experience with cerebrospinal fluid enzymes and electrophysiological measurements is limited. Multivariate scoring systems are not sufficiently reliable. The importance of hyperglycaemia, the required level of CPR ...
Outcomes of Cardiopulmonary Resuscitation and Its Predictors in Hospitalized Patients
Multidisciplinary Cardiovascular Annals
Background: Cardiopulmonary resuscitation (CPR) has been a frequently performed medical intervention that increases the chance of survival of a person stricken by cardiac arrest, and there is an excellent value of diversity in the rate of successful rehabilitation in societies. Methods: A retrospective observational study was carried out. The medical records of all in-hospital and out-hospital cardiac arrest patients who underwent CPR were collected. A total of 587 people with who underwent CPR during two years between January 2017 and June 2018, using a designed form were enrolled. Demographic information, the ward which CPR was committed, hospitalization, the delay before the onset of CPR and time of the day were recorded. Results: The overall success rate of CPR in this study was 25.89%. There was no significant difference in the success rate of CPR between men and women. A comparison of age groups revealed a difference between the success rates of CPR in 14 - 64 years group comp...
BMC Palliative Care, 2019
Background In-hospital cardiopulmonary resuscitation (CPR) is one of undesirable situations. We tried to identify and characterize a potentially avoidable CPR in cancer patients who were hospitalized in hematology and oncology wards. Methods A potentially avoidable CPR was determined based on chemotherapy setting, disease status and clinical situation at the time when a cardiopulmonary arrest occurred, by using a consensus-driven medical records review of two physicians. Results One hundred thirty-seven patients among 12,437 patients hospitalized at hematology and oncology wards between March 2003 and June 2015 (1.1%) underwent a CPR. Eighty-eight patients (64.2%) were men. The majority of patients with a CPR had lung cancer (41, 29.9%), hematologic malignancy (24, 17.5%), stomach cancer (23, 16.8%) or lymphoma (20, 14.6%). A potentially avoidable CPR was identified in 51 patients (37.2%). In a multivariate analysis, advanced diseases and certain tumor types (e.g., lung cancer, lymp...
Factors Associated with Survival Rate after Cardiopulmonary Resuscitation
Journal of Holistic Nursing and Midwifery, 2017
Introduction: Cardiovascular disease is considered as the most important cause of mortality among men and women throughout the world. This condition causes sudden cardiac arrest in more than half of the cases. To reduce mortality due to this disease, cardiopulmonary resuscitation (CPR) and the determinants of its success are the focus of researchers. Objective: The aim of this study was to determine the survival rate of CPR and its associated factors in patients with in-hospital cardiac arrest in a teaching medical center in Rasht. Materials and Methods: The present descriptive-analytic cross-sectional study investigated 100 patients undergoing CPR during spring-summer 2014 at Specialized Cardiology Center in Rasht. The instrument of this study was the standard checklist of Utstein-Style that included information on age, gender, cause of cardiac arrest, rhythm, work shift, CPR place, interval of cardiac arrest until arrival of CPR team, interval of cardiac arrest until shock, interval of cardiac arrest until intubation, interval of cardiac arrest until CPR termination, short-term and long-term outcomes of CPR, and brain function status until discharge from the hospital. Data was analyzed using descriptive statistics (mean, standard deviation) and analytic analyses (T-test, Fisher's exact test, analysis of variance, and logistic regression). Results: A total of 53% of subjects were male and mean age of the patients was 68.6 ± 14.4 years; 30% of patients who underwent CPR had short-term survival, and 11% were discharged with appropriate brain status with Glasgow Coma Scale (GCS=15). Multiple logistic regression (Backward LR method) revealed that only gender (p=0.008, OR=6.46, CI95%: 1.63-25.5) and electric shock (p=0.03, OR=4.1, CI95%: 1.1-15.14) were statistically significant predictors of short-term survival. Conclusion: According to the results of this study, time is an important factor in CPR outcome and increasing the survival rate and timely use of electric shock can be an effective measure in shockable rhythms. Appropriate planning, training staff, and using appropriate facilities, as well as establishment of a primary warning system for calling CPR team in health centers can increase the success rate of CPR.
Unsuccessful resuscitation after cardiac arrest in the intensive care unit: single center analysis 1
complains out of the hospital, so we can assume that the cardiac arrest event they suffered was the result of an acute issue, and not of a prolonged suffering. Nevertheless, facts considered potential factors for a poor outcome in OHCA, such as early recognition of the medical emergency, bystander CPR, early advanced life support, are not an issue for patients admitted in the ICU. The ICU represents a special medical facility with medical personnel of high expertise, nursing care and complex life sustaining medical equipment. The patients admitted in the ICU are in severe condition; therefore it is not unexpected for cardiac arrest to occur. In the Intensive Care Unit (ICU) the patients are permanently monitored, and this fact lowers the possibility for an un-witnessed or unmonitored cardiac arrest to occur (Myrianthefs et al 2003). Nevertheless, the patients admitted in the ICU are already in poor condition, often with hemodynamic and/or respiratory impairment and the characteristi...
Medicine, 2015
Lack of clarity about the exact clinical implications of do-not-resuscitate (DNR) has caused confusion that has been addressed repeatedly in the literature. To provide improved understanding about the portability of DNR and the medical care provided to DNR patients, the state of Ohio passed a Do-Not-Resuscitate Law in 1998, which clearly pointed out 2 different protocols of do-not-resuscitate: DNR comfort care (DNRCC) and DNR comfort care arrest (DNRCC-Arrest). The objective of this study was to examine the outcome of patients with the 2 different protocols of DNR orders.This is a retrospective observational study conducted in a medical intensive care unit (MICU) in a hospital located in Northeast Ohio. The medical records of the initial admissions to the MICU during data collection period were concurrently and retrospectively reviewed. The association between 2 variables was examined using Chi-squared test or Student's t-test. The outcome of DNRCC, DNRCC-Arrest, and No-DNR pati...
The Outcomes of In-hospital Cardiopulmonary Resuscitation: A Cross-sectional Study in Iran
تحقیقات بالینی در علوم پیراپزشکی, 2022
Background: Taking into account the lack of information in this field in Iran, the present study aimed at assessing the five-year epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) in educational centers in Kermanshah. Methods: A cross-sectional study was conducted on 1000 cases of resuscitation. The subjects were selected through systematic random sampling. Data gathering tool included a standard form of in-hospital resuscitation cases based on Utstein style and the framework of and cerebral performance categories (CPC). Results: Out of 1000 cases of resuscitations, 220 cases (22%) had the return of spontaneous circulation and there was 5.2% survival to discharge (STD). Logistic regression test showed that age < 50 years (P = 0.022), primary rhythm (P = 0.012), resuscitation duration (P = 0.001), post resuscitation Glasgow Coma Scale (GCS) (P = 0.001), and cardiac arrest with witness or under monitoring (P = 0.031) had a significant relationship with patient discharge after resuscitation. Therefore, these indices can be used to predict hospital discharge range after resuscitation. According to Fisher's exact test, only post-resuscitation GCS and resuscitation duration had a significant relationship with CPC level (P < 0.001). Conclusions: Despite the improvement of STD over the past few years, these indices are still not comparable with those in other countries. However, the high level of neurological condition of patients at discharge was an indicative of good care services after successful CPRs. This finding can be a motivation for the medical personnel in doing a better CPR operation.
Unsuccessful resuscitation after cardiac arrest in the intensive care unit: single center analysis
2015
complains out of the hospital, so we can assume that the cardiac arrest event they suffered was the result of an acute issue, and not of a prolonged suffering. Nevertheless, facts considered potential factors for a poor outcome in OHCA, such as early recognition of the medical emergency, bystander CPR, early advanced life support, are not an issue for patients admitted in the ICU. The ICU represents a special medical facility with medical personnel of high expertise, nursing care and complex life sustaining medical equipment. The patients admitted in the ICU are in severe condition; therefore it is not unexpected for cardiac arrest to occur. In the Intensive Care Unit (ICU) the patients are permanently monitored, and this fact lowers the possibility for an un-witnessed or unmonitored cardiac arrest to occur (Myrianthefs et al 2003). Nevertheless, the patients admitted in the ICU are already in poor condition, often with hemodynamic and/or respiratory impairment and the characteristi...
International journal of clinical and experimental medicine, 2015
The aim of this study was to evaluate whether there is a difference in the return of spontaneous circulation (ROSC) and survival with sequel-free recovery rates between the patients who underwent cardiopulmonary resuscitation (CPR) according to 2005 and 2010 guidelines. This study was conducted in the Bakırköy Dr. Sadi Konuk and Kartal Lütfi Kırdar Training and Research Hospital between dates of October 2010 and 28 February 2011 after approval of Ethics Committee. In the first months of the study, CPR was performed according to AHA 2005 ACLS guidelines (Group-1), while CPR was performed according to AHA 2010 ACLS guidelines after November 2010 (Group-2). Patients were assessed for neurological deficit with Cerebral Performance Categories Scale. Mean age was found as 69.01±13.05 (minimum: 21, maximum: 92) in 86 patients included. Of the 33 patients underwent CPR in the Group 1, ROSC was achieved in 51.5%; and 6.1% of these patients were discharged. Of the 53 patients underwent CPR in...
In-Hospital Resuscitation: Executive Summary
Annals of Emergency Medicine, 1997
The Emergency Cardiac Care (ECC) Committee of the American Heart Association (AHA) first published guidelines for CPR and ECC in 1974.1 Updated in 1980, 1986, and 1992, the AHA guidelines are now recognized as the world's most authoritative resuscitation guidelines. 2-4 To implement these guidelines, however, hospitals need to establish a systems approach to in-hospital resuscitation rather than depend on the skills of individual professionals. The success and acceptance of the out-of-hospital Utstein style recommendations 5 led the AHA to help develop specific recommendations for documenting in-hospital resuscitation. The Utstein style recommendations for uniform reporting of in-hospital resuscitations present important recommendations for atl hospital facilities. 6 With the publication of these recommendations, members of the ECC Committee recognized the need to summarize the major actions that enable a hospital to fulfill the resuscitation recommendations. ETHICAL CONCERNS CPR is one of the few interventions that requires an order to not be administered. Resuscitation efforts, however, are not appropriate for all hospital patients. When indicated, health care providers discuss with patients, families, and surrogate decisionmakers their options and preferences for resuscitation. Hospitals have in place clear policies that address medical futility, patient self-determination, and do-notattempt-resuscitation orders. IN-HOSPITAL "CHAIN OF SURVIVAL" The chain of survival, first conceptualized for out-of-hospital sudden cardiac arrest, r applies to in-hospital arrest as well. s Successful resuscitation requires early recognition of cardiopulmonary arrest, early activation of trained responders,