Abstract
OBJECTIVE: To analyse the effect on outcome of referral to specialist facilities after cardiopulmonary arrest in a general ward. METHODS: A retrospective analysis of resuscitation records of 743 patients in whom cardiopulmonary resuscitation was performed in a general ward between 1988 and 1992. After successful initial cardiopulmonary resuscitation, patients were identified as transferred to coronary care unit (CCU) or intensive care unit (ITU), or as staying in a general ward. MAIN OUTCOME MEASURE: Survival to discharge home. RESULTS: There were 322 initial survivors, of whom 148 (20% of the overall total) survived to be discharged from hospital; 63% of those transferred to CCU and 48% of those transferred to ITU survived to discharge, compared with 28% of those who stayed on the ward (P < 0.001). Of those aged less than 65 years, 75% survived to discharge after transfer to CCU and 54% after transfer to ITU, compared with 44% of those who stayed on the ward (P = 0.023); the respective figures for those over 65 years were: CCU 25%, ITU 34%, ward 25% (P = 0.014). Only half of those aged more than 65 years were transferred to a specialist facility, compared with 90% of those aged less than 65. CONCLUSIONS: Transfer to a specialist care facility after resuscitation from cardiopulmonary arrest has an influence on outcome. Age as an independent factor is not an appropriate criterion to use in deciding on transfer. The decision to arrange transfer must always be taken by the most experienced person available, and in line with peer reviewed guidelines.
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- Bedell S. E., Delbanco T. L., Cook E. F., Epstein F. H. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983 Sep 8;309(10):569–576. doi: 10.1056/NEJM198309083091001. [DOI] [PubMed] [Google Scholar]
- Doyal L., Wilsher D. Withholding cardiopulmonary resuscitation: proposals for formal guidelines. BMJ. 1993 Jun 12;306(6892):1593–1596. doi: 10.1136/bmj.306.6892.1593. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gustafson I., Edgren E., Hulting J. Brain-oriented intensive care after resuscitation from cardiac arrest. Resuscitation. 1992 Dec;24(3):245–261. doi: 10.1016/0300-9572(92)90185-f. [DOI] [PubMed] [Google Scholar]
- Hershey C. O., Fisher L. Why outcome of cardiopulmonary resuscitation in general wards is poor. Lancet. 1982 Jan 2;1(8262):31–34. doi: 10.1016/s0140-6736(82)92567-3. [DOI] [PubMed] [Google Scholar]
- Levy R. D., Rhoden W. E., Shearer K., Varley E., Brooks N. H. An audit of drug usage for in-hospital cardiopulmonary resuscitation. Eur Heart J. 1992 Dec;13(12):1665–1668. doi: 10.1093/oxfordjournals.eurheartj.a060122. [DOI] [PubMed] [Google Scholar]
- Ryan B. P., Redmond A. D., Edwards J. D. When to stop resuscitation--the significance of cuff blood pressure. Arch Emerg Med. 1991 Sep;8(3):177–181. doi: 10.1136/emj.8.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thomassen A., Wernberg M. Prevalence and prognostic significance of coma after cardiac arrest outside intensive care and coronary units. Acta Anaesthesiol Scand. 1979 Apr;23(2):143–148. doi: 10.1111/j.1399-6576.1979.tb01434.x. [DOI] [PubMed] [Google Scholar]
- Tunstall-Pedoe H., Bailey L., Chamberlain D. A., Marsden A. K., Ward M. E., Zideman D. A. Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. BMJ. 1992 May 23;304(6838):1347–1351. doi: 10.1136/bmj.304.6838.1347. [DOI] [PMC free article] [PubMed] [Google Scholar]