BACKGROUND. The majority of attempts to resuscitate victims of prehospital cardiopulmonary arrest are unsuccessful, and patients are frequently transported to the emergency department for further resuscitation efforts. We evaluated the efficacy and costs of continued hospital resuscitation for patients in whom resuscitation efforts outside the hospital have failed. METHODS. We reviewed the records of 185 patients presenting to our emergency department after an initially unsuccessful, but ongoing, resuscitation for a prehospital arrest (cardiac, respiratory, or both) by an emergency medical team. Prehospital and hospital characteristics of treatment for the arrest were identified, and the patients' outcomes in the emergency room were ascertained. The hospital course and the hospital costs for the patients who were revived were determined. RESULTS. Over a 19-month period, only 16 of the 185 patients (9 percent) were successfully resuscitated in the emergency department and admitted to the hospital. A shorter duration of prehospital resuscitation was the only characteristic of the resuscitation associated with an improved outcome in the emergency department. No patient survived until hospital discharge, and all but one were comatose throughout hospitalization. The mean stay in the hospital was 12.6 days (range, 1 to 132), with an average of 2.3 days (range, 1 to 11) in an intensive care unit. The total hospital cost for the 16 patients admitted was $180,908 (range per patient, $1,984 to $95,144). CONCLUSIONS. In general, continued resuscitation efforts in the emergency department for victims of cardiopulmonary arrest in whom prehospital resuscitation has failed are not worthwhile, and they consume precious institutional and economic resources without gain.
Source Information
Division of Cardiology, Rhode Island Hospital, Providence 02903.
This article has been cited by other articles:
Neumar, R. W., Nolan, J. P., Adrie, C., Aibiki, M., Berg, R. A., Bottiger, B. W., Callaway, C., Clark, R. S.B., Geocadin, R. G., Jauch, E. C., Kern, K. B., Laurent, I., Longstreth, W.T. Jr, Merchant, R. M., Morley, P., Morrison, L. J., Nadkarni, V., Peberdy, M. A., Rivers, E. P., Rodriguez-Nunez, A., Sellke, F. W., Spaulding, C., Sunde, K., Vanden Hoek, T.
(2008). Post-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation
118: 2452-2483
[Full Text]
Eisenburger, P., Havel, C., Sterz, F., Uray, T., Zeiner, A., Haugk, M., Losert, H., Laggner, A. N., Herkner, H.
(2008). Transport with ongoing cardiopulmonary resuscitation may not be futile. Br J Anaesth
101: 518-522
[Abstract][Full Text]
Morrison, L. J., Visentin, L. M., Kiss, A., Theriault, R., Eby, D., Vermeulen, M., Sherbino, J., Verbeek, P. R., the TOR Investigators,
(2006). Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.. NEJM
355: 478-487
[Abstract][Full Text]
Wijdicks, E.F.M., Hijdra, A., Young, G. B., Bassetti, C. L., Wiebe, S.
(2006). Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.. Neurology
67: 203-210
[Abstract][Full Text]
Delea, T. E, Jacobson, T. A, Serruys, P. W., Edelsberg, J. S, Oster, G.
(2005). Cost-Effectiveness of Fluvastatin Following Successful First Percutaneous Coronary Intervention. The Annals of Pharmacotherapy
39: 610-616
[Abstract][Full Text]
Herlitz, J, Engdahl, J, Svensson, L, Young, M, Angquist, K-A, Holmberg, S
(2004). Can we define patients with no chance of survival after out-of-hospital cardiac arrest?. Heart
90: 1114-1118
[Abstract][Full Text]
Zafari, A. M., Zarter, S. K., Heggen, V., Wilson, P., Taylor, R. A., Reddy, K., Backscheider, A. G., Dudley, S. C. Jr
(2004). A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol
44: 846-852
[Abstract][Full Text]
Dumot, J. A., Burval, D. J., Sprung, J., Waters, J. H., Mraovic, B., Karafa, M. T., Mascha, E. J., Bourke, D. L.
(2001). Outcome of Adult Cardiopulmonary Resuscitations at a Tertiary Referral Center Including Results of "Limited" Resuscitations. Arch Intern Med
161: 1751-1758
[Abstract][Full Text]
Gueugniaud, P.-Y., Mols, P., Goldstein, P., Pham, E., Dubien, P.-Y., Deweerdt, C., Vergnion, M., Petit, P., Carli, P., The European Epinephrine Study Group,
(1998). A Comparison of Repeated High Doses and Repeated Standard Doses of Epinephrine for Cardiac Arrest Outside the Hospital. NEJM
339: 1595-1601
[Abstract][Full Text]
Zweig, S. C.
(1997). Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders in the Nursing Home. Arch Fam Med
6: 424-429
[Abstract]
Levine, R. L., Wayne, M. A., Miller, C. C.
(1997). End-Tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest. NEJM
337: 301-306
[Abstract][Full Text]
Cummins, R. O., Chamberlain, D., Hazinski, M. F., Nadkarni, V., Kloeck, W., Kramer, E., Becker, L., Robertson, C., Koster, R., Zaritsky, A., Bossaert, L., Ornato, J. P., Callanan, V., Allen, M., Steen, P., Connolly, B., Sanders, A., Idris, A., Cobbe, S.
(1997). Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital `Utstein Style' : A Statement for Healthcare Professionals From the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Circulation
95: 2213-2239
[Full Text]
Broyles, R. S., Tyson, J. E., Swint, J. M.
(1997). Have Medicaid Reimbursements Been a Credible Measure of the Cost of Pediatric Care?. Pediatrics
99: e8-e8
[Abstract][Full Text]
Schindler, M. B., Bohn, D., Cox, P. N., McCrindle, B. W., Jarvis, A., Edmonds, J., Barker, G.
(1996). Outcome of Out-of-Hospital Cardiac or Respiratory Arrest in Children. NEJM
335: 1473-1479
[Abstract][Full Text]
Karetzky, M., Zubair, M., Parikh, J.
(1995). Cardiopulmonary Resuscitation in Intensive Care Unit and Non--Intensive Care Unit Patients: Immediate and Long-term Survival. Arch Intern Med
155: 1277-1280
[Abstract]
Ronco, R., King, W., Donley, D. K., Tilden, S. J.
(1995). Outcome and Cost at a Children's Hospital Following Resuscitation for Out-of-Hospital Cardiopulmonary Arrest. Arch Pediatr Adolesc Med
149: 210-214
[Abstract]
Schoenenberger, R. A., von Planta, M., von Planta, I.
(1994). Survival After Failed Out-of-Hospital Resuscitation: Are Further Therapeutic Efforts in the Emergency Department Futile?. Arch Intern Med
154: 2433-2437
[Abstract]
Berwick, D. M.
(1994). Eleven Worthy Aims for Clinical Leadership of Health System Reform. JAMA
272: 797-802
[Abstract]
McCoy, M. L.
(1994). Out-of-Hospital CPR. JAMA
271: 748-748
[Abstract]
Lombardi, G., Gallagher, E. J., Paul,
(1994). Outcome of Out-of-Hospital Cardiac Arrest in New York City: The Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA
271: 678-683
[Abstract]
Jayes, R. L., Zimmerman, J. E., Wagner, D. P., Draper, E. A., Knaus, W. A., Chernow, B., Dantzker, D., Leiken, J., Parrillo, J. E., Sibbald, W. J., Vincent, J.-L.
(1993). Do-Not-Resuscitate Orders in Intensive Care Units: Current Practices and Recent Changes. JAMA
270: 2213-2217
[Abstract]
Jecker, N. S., Schneiderman, L. J.
(1993). An Ethical Analysis of the Use of 'Futility' in the 1992 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. Arch Intern Med
153: 2195-2198
[Abstract]
Kavolius, J., Golocovsky, M., Champion, H. R.
(1993). Predictors of Outcome in Patients Who Have Sustained Trauma and Who Undergo Emergency Thoracotomy. Arch Surg
128: 1158-1162
[Abstract]
Kellermann, A. L., Hackman, B. B., Somes, G.
(1993). Predicting the Outcome of Unsuccessful Prehospital Advanced Cardiac Life Support. JAMA
270: 1433-1436
[Abstract]
Bonnin, M. J., Pepe, P. E., Kimball, K. T., Clark, P. S. Jr
(1993). Distinct Criteria for Termination of Resuscitation in the Out-of-Hospital Setting. JAMA
270: 1457-1462
[Abstract]
Gray, W. A.
(1993). Prehospital Resuscitation: The Good, the Bad, and the Futile. JAMA
270: 1471-1472
[Abstract]
Murphy, D. J., Finucane, T. E.
(1993). New Do-Not-Resuscitate Policies: A First Step in Cost Control. Arch Intern Med
153: 1641-1648
[Abstract]
Pellegrino, E. D.
(1993). Ethics. JAMA
270: 202-203
[Abstract]
Jecker, N. S., Schneiderman, L. J.
(1992). Ceasing Futile Resuscitation in the Field: Ethical Considerations. Arch Intern Med
152: 2392-2397
[Abstract]
(1992). Ethical Considerations in Resuscitation. JAMA
268: 2282-2288
[Abstract]
