Outcomes and Cost Analysis of Patients With Successful In-Hospital Cardiopulmonary Resuscitation

SummaryBackgroundsThis study evaluated the outcomes of patients after in-hospital cardiac arrest who were admitted to the intensive care unit (ICU) with successful cardiopulmonary resuscitation (CPR).MethodsData were extracted from a prospectively maintained database of intubation and mechanical ventilation in a tertiary hospital. Adult patients (age ≥ 18 years) with successful CPR and admitted to the ICU were included for analysis. The characteristics of the patients and the outcomes were analyzed.ResultsA total of 313 patients were included from January 1, 2004, to December 31, 2004, with 114 (36.4%) admitted from the emergency department and 199 (63.6%) from the ward. The in-hospital mortality was high (209, 66.8%), with 130 (62.2%) of the patients dying within 24 hours. The nonsurvivors had a significantly higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Therapeutic Intervention Scoring System (TISS) score but a lower Glasgow Coma Scale (GCS), a shorter ICU and hospital stay, shorter mechanical ventilation (MV) hours, and fewer expenses. Patients with early mortality (< 24 hours) had a significantly higher APACHE II score and a greater portion were admitted from the ward. Only 73 (23.3%) were discharged home and 31 (9.9%) were transferred to a chronic care center. Patients who were discharged to chronic care centers were older, had a higher APACHE II score, higher medical expenses, more MV hours, longer ICU and hospital stays, but a lower GCS than those who were discharged home. The mean expense for survivors was about threefold that of nonsurvivors, and patients who were discharged to a chronic care center had the highest mean hospital expense, which was about sixfold of the patients with early mortality. Although survivors comprised 33.3% of the in-hospital cardiac arrest patients with return of spontaneous circulation, they have consumed 60% of the total hospital expenses.ConclusionsGiven the fact that less than one quarter of the successfully resuscitated patients have a favorable outcome, two-thirds of the mortality cases died within 24 hours, which is a high cost for successful resuscitation, and one-third of the survivors had to stay on chronic respiratory care center. A better prognostic tool to predict outcomes should be developed to avoid futile resuscitation.