Outcome of cardiopulmonary resuscitation in the intensive care setting.
BACKGROUND: Although cardiopulmonary resuscitation (CPR) has been shown to be most effective in a monitored setting, previous studies have focused primarily on patients with acute cardiac events rather than chronic progressive disease. This study examined the outcome of CPR in the medical and surgical intensive care units where patients often have acute illness superimposed on chronic underlying conditions. METHODS: We present a retrospective chart review of all patients undergoing CPR in medical and surgical intensive care units during a 2-year period. RESULTS: One hundred fourteen charts were reviewed. Patient mean age was 59 years. The primary underlying disease was malignancy in 29 (25%), vascular disease in 20 (18%), chronic liver disease in eight (7%), end-stage renal disease in six (5%), chronic obstructive pulmonary disease in five (5%), and other conditions in 46 (40%) patients. Although 50 (44%) of the patients were initially resuscitated, only six (5%) ultimately survived to hospital discharge. Only one of 29 patients with malignancy and one of 39 septic patients survived. Age, sex, and Acute Physiology and Chronic Health Evaluation II scores were similar among survivors and nonsurvivors. Furthermore, four of the six survivors died within 1 year of discharge, and the two others had severe disabilities. CONCLUSIONS: Patients with chronic medical conditions undergoing CPR even in an intensive care unit setting seldom survive to hospital discharge. Even among the few survivors, the near term prognosis is poor. Therefore, the decision to perform CPR should take into account underlying chronic medical conditions and not merely the setting of the arrest.