Current Cardiology Reports

, 16:457

Using Risk Prediction Tools in Survivors of In-hospital Cardiac Arrest

  • Saket Girotra
  • Brahmajee K. Nallamothu
  • Paul S. Chan
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease


In-hospital cardiac arrests are common and associated with poor outcomes. Predicting the likelihood of favorable neurological survival following resuscitation from an in-hospital cardiac arrest could provide important information for physicians and families. In this article, we review the literature regarding predictors of survival following in-hospital cardiac arrest. Specifically, we describe the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) score that was recently developed and validated using data from the Get With the Guidelines-Resuscitation registry. The CASPRI score includes 11 predictor variables: age, initial cardiac arrest rhythm, defibrillation time, baseline neurological status, duration of resuscitation, mechanical ventilation, renal insufficiency, hepatic insufficiency, sepsis, malignancy, and hypotension. The score is simple to use at the bedside, has excellent discrimination and calibration, and provides robust estimates of the probability of favorable neurological survival after an in-hospital cardiac arrest. Thus, CASPRI may be valuable in establishing expectations by physicians and families in the critical period after these high-risk events.


In-hospital cardiac arrest Resuscitation Survival Risk prediction tools 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Merchant RM, Yang L, Becker LB, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States. Crit Care Med. 2011;39:2401–6.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Ehlenbach WJ, Barnato AE, Curtis JR, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009;361:22–31.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Kazaure HS, Roman SA, Sosa JA. Epidemiology and Outcomes of In-Hospital Cardiopulmonary Resuscitation in the United States, 2000-2009. Resuscitation. 2013;84:1255–60.PubMedCrossRefGoogle Scholar
  4. 4.••
    Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367:1912–20. This study describes temporal trends in survival and neurological outcomes among in-hospital cardiac arrest victims during the past decade..Google Scholar
  5. 5.
    Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Peberdy MA, Callaway CW, Neumar RW, et al. Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S768–86. Scientific statement from the American Heart Association that summarizes the evidence regarding post-resuscitation care..PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper S, Janghorbani M, Cooper G. A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation. 2006;68:231–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Cooper S, Cade J. Predicting survival, in-hospital cardiac arrests: resuscitation survival variables and training effectiveness. Resuscitation. 1997;35:17–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Tunstall-Pedoe H, Bailey L, Chamberlain DA, Marsden AK, Ward ME, Zideman DA. Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. BMJ. 1992;304:1347–51.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Skrifvars MB, Castren M, Nurmi J, Thoren AB, Aune S, Herlitz J. Do patient characteristics or factors at resuscitation influence long-term outcome in patients surviving to be discharged following in-hospital cardiac arrest? J Intern Med. 2007;262:488–95.PubMedCrossRefGoogle Scholar
  11. 11.
    Schultz SC, Cullinane DC, Pasquale MD, Magnant C, Evans SR. Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation. 1996;33:13–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Sandroni C, Ferro G, Santangelo S, et al. In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation. 2004;62:291–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Ballew KA, Philbrick JT, Caven DE, Schorling JB. Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target. Arch Intern Med. 1994;154:2426–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Chan PS, Nichol G, Krumholz HM, et al. Racial differences in survival after in-hospital cardiac arrest. JAMA. 2009;302:1195–201. This paper examines disparities in outcomes between black and white patients with in-hospital cardiac arrest due to ventricular fibrillation or ventricular tachycardia, including the potential source of the disparties..PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Topjian AA, Localio AR, Berg RA, et al. Women of child-bearing age have better inhospital cardiac arrest survival outcomes than do equal-aged men. Crit Care Med. 2010;38:1254–60.PubMedCentralPubMedGoogle Scholar
  17. 17.••
    Chan PS, Spertus JA, Krumholz HM, et al. A validated prediction tool for initial survivors of in-hospital cardiac arrest. Arch Intern Med. 2012;172:947–53. This paper describes the development and validation of the Cardiac Arrest Survival Postresuscitation In-hospital (CASPRI) prediction tool - which was designed to predict the likelihood of survival without severe neurological disability in initial survivors of in-hospital cardiac arrest..PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    George Jr AL, Folk 3rd BP, Crecelius PL, Campbell WB. Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. Am J Med. 1989;87:28–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Ebell MH. Prearrest predictors of survival following in-hospital cardiopulmonary resuscitation: a meta-analysis. J Fam Prac. 1992;34:551–8.Google Scholar
  20. 20.
    Herlitz J, Bang A, Alsen B, Aune S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation. 2002;53:127–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008;358:9–17.PubMedCrossRefGoogle Scholar
  22. 22.
    Peberdy MA, Ornato JP, Larkin GL, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008;299:785–92. This paper showed that outcomes in patients with in-hospital cardiac arrest were between daytime hours and night, as well as weekdays and weekend.PubMedCrossRefGoogle Scholar
  23. 23.
    Stemmler EJ. Cardiac resuscitation. A 1-year study of patients resuscitated within a university hospital. Ann Intern Med. 1965;63:613–8.PubMedCrossRefGoogle Scholar
  24. 24.•
    Goldberger ZD, Chan PS, Berg RA, et al. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study. Lancet. 2012. doi:10.1016/S0140-6736(12)60862-9. This paper showed that hospitals that have a tendency to continue resuscitation efforts for a longer period (as measured by the duration of resuscitation among non-survivors) had better overall in-hospital cardiac arrest survival..PubMedCentralPubMedGoogle Scholar
  25. 25.
    Herlitz J, Bang A, Aune S, Ekstrom L, Lundstrom G, Holmberg S. Characteristics and outcome among patients suffering in-hospital cardiac arrest in monitored and non-monitored areas. Resuscitation. 2001;48:125–35.PubMedCrossRefGoogle Scholar
  26. 26.
    Ebell MH, Kruse JA, Smith M, Novak J, Drader-Wilcox J. Failure of three decision rules to predict the outcome of in-hospital cardiopulmonary resuscitation. Med Dec Making: Intern J Soc Med Dec Making. 1997;17:171–7.CrossRefGoogle Scholar
  27. 27.
    O'Keeffe S, Ebell MH. Prediction of failure to survive following in-hospital cardiopulmonary resuscitation: comparison of two predictive instruments. Resuscitation. 1994;28:21–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.PubMedCrossRefGoogle Scholar
  29. 29.
    Cummins RO, Chamberlain D, Hazinski MF, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. Circulation. 1997;95:2213–39.PubMedCrossRefGoogle Scholar
  30. 30.
    Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Saket Girotra
    • 1
  • Brahmajee K. Nallamothu
    • 2
  • Paul S. Chan
    • 3
    • 4
  1. 1.Department of Internal Medicine, Division of Cardiovascular DiseasesUniversity of Iowa Carver College of MedicineIowa CityUSA
  2. 2.Department of Internal Medicine, Division of Cardiovascular DiseasesUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.Department of Medicine, Division of Cardiovascular DiseasesUniversity of Missouri-Kansas CityKansas CityUSA
  4. 4.St. Luke’s Mid America Heart InstituteKansas CityUSA

Personalised recommendations