Gender, rhythm, CPR duration independently predict death after ICU cardiac arrest
MedWire News: Gender, presenting rhythm, and duration of cardiopulmonary resuscitation (CPR) are independent predictors of mortality 24 hours after cardiac arrest in an intensive care unit (ICU), study findings suggest.
In particular, the research showed that patients who presented with pulseless electrical activity or asystole in the ICU had lower survival rates after cardiac arrest than those who presented with other types of cardiac rhythms, report Peter Brindley (University of Alberta, Edmonton, Canada) and colleagues in the Canadian Medical Association Journal.
The team evaluated survival outcomes and risk factors among 517 patients (62.3% men) with a mean age of 66.5 years, who experienced a cardiac or respiratory arrest in an ICU from January 1, 2000 through April 30, 2005.
In all, 59.6% of the patients were able to be resuscitated, 30.4% survived to discharge from ICU, 26.9% survived to discharge from hospital, and 15.9% survived to 5 years.
Pulseless electrical activity or asystole was the most common rhythm, accounting for 45.8% of the arrests in total. Patients with pulseless electrical activity or asystole had the lowest survival rates, with 10.6% surviving to 1 year versus 36.3% who experienced other cardiac rhythms (p<0.001).
Multivariate analysis revealed that male gender, arrest due to pulseless electrical activity or asystole, and longer CPR duration were significantly associated with an increased risk for death within 24 hours after arrest (odds ratio [OR]=1.55, 3.37, and 2.59 per additional logarithm of a minute of CPR, respectively).
Further analysis revealed that increasing age and longer CPR duration were independent predictors of survival to 8 months or more (OR=1.06 per year increase and OR=1.38 per additional logarithm of a minute of CPR).
"A key strategy to prevent or mitigate arrests needs to include earlier identification and response," the authors conclude.
In a related commentary, editorialist Benjamin Abella (University of Pennsylvania, Philadelphia, USA) called for the treatment of cardiac arrest to be customized to each patient's individual needs.
He concluded that this would be "an important step forward" to improve patient survival after cardiac arrest.
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By Piriya Mahendra