Survival in Patients Taking Pressors before Cardiopulmonary Arrest

New research shows that although only 15.9% of patients who arrest in the ICU survive to hospital discharge, outcomes were even worse for those requiring hemodynamic support.

In the study, Jianmin Tian, MD, of Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT, and colleagues for the American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators examined survival outcomes of ICU patients who received cardiopulmonary resuscitation. The authors analyzed data from 49,656 adult patients with a first cardiopulmonary arrest (CPA) occurring in an ICU between January 2000 and August 2008 within the National Registry of Cardiopulmonary Resuscitation.

According to a report of the study published in the American Journal of Respiratory and Critical Care Medicine, Tian and colleagues compared survival outcomes of patients requiring hemodynamic support immediately before CPA with those of patients who didn’t receive hemodynamic support (pressors), using multivariable logistic regression analyses to adjust for differences in demographics and clinical characteristics. Pressor medications included epinephrine, norepinephrine, phenylephrine, dopamine, dobutamine, and vasopressin.

The investigators found that the overall rate of survival to hospital discharge was 15.9%; however, it was even lower—9.3%—for patients taking pressors before CPA. After multivariable adjustment, it was determined that “patients taking pressors before pulseless CPA were 55% less likely to survive to discharge.” Other variables associated with lower survival rates post-ICU arrest including being over the age of 65, being nonwhite, or being on mechanical ventilation.

According to the study, “more than half of survivors were discharged to rehabilitation or extended care facilities, and “only 3.9% of patients who had CPA despite pressors were discharged home from the hospital, as compared with 8.5% of patients with a CPA and not taking pressors.”

These findings, they concluded, provide “robust estimates of CPR outcomes of critically ill patients, and may assist clinicians to inform consent for this procedure.” The research is also significant, the authors wrote, because it is the first large-scale study to describe outcomes of critically ill patients who receive cardiopulmonary resuscitation.

For more on this topic:

• Journal of Critical Care—Outcomes of cardiopulmonary resuscitation for patients on vasopressors or inotropes: a pilot study
• Journal of the American Academy of Physician Assistants—Have the latest CPR guidelines improved cardiac arrest outcomes?
• DrPullen.com: Not Dead Until Warm and Dead