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Intensive Care Medicine

, Volume 40, Issue 4, pp 556–563 | Cite as

Cardiopulmonary resuscitation among mechanically ventilated patients

  • Ali Al-Alwan
  • William J. Ehlenbach
  • Prema R. Menon
  • Michael P. Young
  • Renee D. StapletonEmail author
Original

Abstract

Purpose

To evaluate the outcomes, including long-term survival, after cardiopulmonary resuscitation (CPR) in mechanically ventilated patients.

Methods

We analyzed Medicare data from 1994 to 2005 to identify beneficiaries who underwent in-hospital CPR. We then identified a subgroup receiving CPR one or more days after mechanical ventilation was initiated [defined by ICD-9 procedure code for intubation (96.04) or mechanical ventilation (96.7x) one or more days prior to procedure code for CPR (99.60 or 99.63)].

Results

We identified 471,962 patients who received in-hospital CPR with an overall survival to hospital discharge of 18.4 % [95 % confidence interval (CI) 18.3–18.5 %]. Of those, 42,163 received CPR one or more days after mechanical ventilation initiation. Survival to hospital discharge after CPR in ventilated patients was 10.1 % (95 % CI 9.8–10.4 %), compared to 19.2 % (95 % CI 19.1–19.3 %) in non-ventilated patients (p < 0.001). Among this group, older age, race other than white, higher burden of chronic illness, and admission from a nursing facility were associated with decreased survival in multivariable analyses. Among all CPR recipients, those who were ventilated had 52 % lower odds of survival (OR 0.48, 95 % CI 0.46–0.49, p < 0.001). Median long-term survival in ventilated patients receiving CPR who survived to hospital discharge was 6.0 months (95 % CI 5.3–6.8 months), compared to 19.0 months (95 % CI 18.6–19.5 months) among the non-ventilated survivors (p < 0.001 by logrank test). Of all patients receiving CPR while ventilated, only 4.1 % were alive at 1 year.

Conclusions

Survival after in-hospital CPR is decreased among ventilated patients compared to those who are not ventilated. This information is important for clinicians, patients, and family members when discussing CPR in critically ill patients.

Keywords

Cardiopulmonary arrest Outcome Predictors Survival Quality of life 

Abbreviations

CPA

Cardiopulmonary arrest

CPR

Cardiopulmonary resuscitation

ICD-9

International Classification of Diseases, Ninth Revision

ICU

Intensive care unit

SNF

Skilled nursing facility

Notes

Acknowledgments

This research was supported by an ASP-CHEST Foundation of the American College of Chest Physicians-Geriatric Development Research Award funded by Atlantic Philanthropies, CHEST Foundation, the John A. Hartford Foundation, and the Association of Specialty Professors (Stapleton). It was also supported by a National Institutes of Health/National Center for Research Resources Roadmap K12 Award (8K12RR023265, Stapleton) and an NCRR Center of Biomedical Research Excellence (COBRE) Award (5P20RR015557, Stapleton). Additional funding included a Paul Beeson Career Development Award in Aging Research (5K23AG038352) funded by the National Institute on Aging, The Atlantic Philanthropies, the John A. Hartford Foundation, the Starr Foundation, and an anonymous donor (Ehlenbach) and a National Heart, Lung, and Blood Training Grant (T32HL076122, Menon).

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Ali Al-Alwan
    • 1
  • William J. Ehlenbach
    • 2
  • Prema R. Menon
    • 3
  • Michael P. Young
    • 4
  • Renee D. Stapleton
    • 3
    Email author
  1. 1.Seacoast Pulmonary MedicineWentworth-Douglass HospitalDoverUSA
  2. 2.Division of Pulmonary and Critical Care MedicineUniversity of WisconsinMadisonUSA
  3. 3.Division of Pulmonary and Critical Care MedicineUniversity of Vermont College of MedicineBurlingtonUSA
  4. 4.Division of Pulmonary, Critical Care, Allergy, and Immunologic MedicineWake Forest University Baptist Medical CenterWinston-SalemUSA

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