Skip to main content
SpringerLink
Log in

Cardiopulmonary resuscitation among mechanically ventilated patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CPA:

Cardiopulmonary arrest

CPR:

Cardiopulmonary resuscitation

ICD-9:

International Classification of Diseases, Ninth Revision

ICU:

Intensive care unit

SNF:

Skilled nursing facility

References

  1. American Heart association (2013) About cardiopulmonary resuscitation (CPR). In: highlights of the history of cardiopulmonary resuscitation (CPR). American Heart association. DIALOG. http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/History-of-CPR_UCM_307549_Article.jsp. Accessed 19 August 2013

  2. Kouwenhoven WB, Jude JR, Knickerbocker GG (1960) Closed-chest cardiac massage. JAMA 173:94–97

    Article  Google Scholar 

  3. Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A (2013) Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med 39:1972–1980. doi:10.1007/s00134-013-3043-4

    Article  PubMed  Google Scholar 

  4. Begg CB, Riedel ER, Bach PB et al (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346:1138–1144

    Article  PubMed  Google Scholar 

  5. Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474

    Article  PubMed  CAS  Google Scholar 

  6. Sharma G, Freeman J, Zhang D, Goodwin JS (2009) Continuity of care and intensive care unit use at the end of life. Arch Intern Med 169:81–86

    Article  PubMed  PubMed Central  Google Scholar 

  7. Arday SL, Arday DR, Monroe S, Zhang J (2000) HCFA’s racial and ethnic data: current accuracy and recent improvements. Health Care Financ Rev 21:107–116

    PubMed  CAS  Google Scholar 

  8. Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139

    Article  PubMed  Google Scholar 

  9. Morrill R, Cromartie J, Hart G (1999) Metropolitan, urban, and rural commuting areas: toward a better depiction of the United States settlement system. Urban Geogr 20:727–748

    Article  Google Scholar 

  10. Tian J, Kaufman DA, Zarich S et al (2010) Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 182:501–506

    Article  PubMed  Google Scholar 

  11. Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG (2011) Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ 183:1589–1595

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245

    Article  PubMed  Google Scholar 

  13. Peberdy MA, Kaye W, Ornato JP et al (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58:297–308

    Article  PubMed  Google Scholar 

  14. Sandroni C, Ferro G, Santangelo S et al (2004) In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation 62:291–297

    Article  PubMed  Google Scholar 

  15. Breslow MJ, Badawi O (2012) Severity scoring in the critically ill: part 1-interpretation and accuracy of outcomes prediction scoring systems. Chest 141:245–252

    Article  PubMed  Google Scholar 

  16. Daly BJ, Douglas SL, Gordon NH et al (2009) Composite outcomes of chronically critically ill patients 4 months after hospital discharge. Am J Crit Care 18:456–464

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lannon R, O’Keeffe ST (2010) Cardiopulmonary resuscitation in older people—a review. Rev Clin Gerontol 20:20–29

    Article  Google Scholar 

  18. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, American Heart Association Get with the Guidelines-Resuscitation Investigators (2012) Trends in survival after in-hospital cardiac arrest. N Engl J Med 367:1912–1920

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Larkin GL, Copes WS, Nathanson BH, Kaye W (2010) Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation. Resuscitation 81:302–311

    Article  PubMed  Google Scholar 

  20. Ebell MH, Becker LA, Barry HC, Hagen M (1998) Survival after in-hospital cardiopulmonary resuscitation. A meta analysis. J Gen Intern Med 13:805–816

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. Watkins LO (2004) Epidemiology and burden of cardiovascular disease. Clin Cardiol 27(6 Suppl 3):III 2–III 6

    Article  Google Scholar 

  22. Ebell MH, Smith M, Kruse JA, Drader-Wilcox J, Novak J (1995) Effect of race on survival following in-hospital cardiopulmonary resuscitation. J Fam Pract 40:571–577

    PubMed  CAS  Google Scholar 

  23. Virnig BA, Lurie N, Huang Z, Musgrave D, McBean AM, Dowd B (2002) Racial variation in quality of care among Medicare + Choice enrollees. Health Aff (Millwood) 21:224–230

    Article  Google Scholar 

  24. Galea S, Blaney S, Nandi A et al (2007) Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol 166:534–543

    Article  PubMed  CAS  Google Scholar 

  25. Barnato AE, Chang CC, Saynina O, Garber AM (2007) Influence of race on inpatient treatment intensity at the end of life. J Gen Intern Med 22:338–345

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shepardson LB, Gordon HS, Ibrahim SA, Harper DL, Rosenthal GE (1999) Racial variation in the use of do-not-resuscitate orders. J Gen Intern Med 14:15–20

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Wenger NS, Pearson ML, Desmond KA (1995) Epidemiology of do-not-resuscitate orders: disparity by age, diagnosis, gender, race, and functional impairment. Arch Intern Med 155:2056–2062

    Article  PubMed  CAS  Google Scholar 

  28. Levy CR, Fish R, Kramer A (2005) Do-not-resuscitate and do-not-hospitalize directives of persons admitted to skilled nursing facilities under the Medicare benefit. J Am Geriatr Soc 53:2060–2068

    Article  PubMed  Google Scholar 

  29. Rich SE, Gruber-Baldini AL, Quinn CC, Zimmerman SI (2009) Discussion as a factor in racial disparity in advance directive completion at nursing home admission. J Am Geriatr Soc 57:146–152

    Article  PubMed  PubMed Central  Google Scholar 

  30. Skogvoll E, Isern E, Sangolt GK, Gisvold SE (1999) In-hospital cardiopulmonary resuscitation. 5 years’ incidence and survival according to the Utstein template. Acta Anaesthesiol Scand 43:177–184

    Article  PubMed  CAS  Google Scholar 

  31. Nadkarni VM, Larkin GL, Peberdy MA et al (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295:50–57

    Article  PubMed  CAS  Google Scholar 

  32. Mayr VD, Dünser MW, Greil V et al (2006) Causes of death and determinants of outcome in critically ill patients. Crit Care 10:R154. doi:10.1186/cc5086

    Article  PubMed  PubMed Central  Google Scholar 

  33. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  PubMed  CAS  Google Scholar 

  34. Wallmuller C, Meron G, Kurkciyan I, Schober A, Stratil P, Sterz F (2012) Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation 83:1206–1211

    Article  PubMed  Google Scholar 

  35. Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD (2009) Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 361:22–31

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  36. Saklayen M, Liss H, Markert R (1995) In-hospital cardiopulmonary resuscitation: survival in 1 hospital and literature review. Medicine (Baltimore) 74:163–175

    Article  CAS  Google Scholar 

  37. Cohn AC, Wilson WM, Yan B et al (2004) Analysis of clinical outcomes following in-hospital adult cardiac arrest. Intern Med J 34:398–402

    Article  PubMed  CAS  Google Scholar 

  38. Zoch TW, Desbiens NA, DeStefano F, Stueland DT, Layde PM (2000) Short- and long-term survival after cardiopulmonary resuscitation. Arch Intern Med 160:1969–1973

    Article  PubMed  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Seacoast Pulmonary Medicine, Wentworth-Douglass Hospital, 789 Central Avenue, Dover, NH, 03820, USA

    Ali Al-Alwan

  2. Division of Pulmonary and Critical Care Medicine, University of Wisconsin, 1685 Highland Ave, Madison, WI, 53705, USA

    William J. Ehlenbach

  3. Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, 149 Beaumont Ave, HSRF 222, Burlington, VT, 05405, USA

    Prema R. Menon & Renee D. Stapleton

  4. Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Michael P. Young

Authors
  1. Ali Al-Alwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William J. Ehlenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prema R. Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael P. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Renee D. Stapleton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renee D. Stapleton.

Additional information

Take-home message:

Survival to hospital discharge among patients who are mechanically ventilated prior to receiving CPR is lower than among non-ventilated patients. These findings are important for clinicians, patients, and family members when discussing and making decisions about CPR in mechanically ventilated patients.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Al-Alwan, A., Ehlenbach, W.J., Menon, P.R. et al. Cardiopulmonary resuscitation among mechanically ventilated patients. Intensive Care Med 40, 556–563 (2014). https://doi.org/10.1007/s00134-014-3247-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-014-3247-2

Keywords

Search

Navigation