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Background It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.
Methods We examined fee-for-service Medicare data from 1992 through 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. We examined temporal trends in the incidence of CPR and the rate of survival after CPR, as well as patient- and hospital-level predictors of survival to discharge.
Results We identified 433,985 patients who underwent in-hospital CPR; 18.3% of these patients (95% confidence interval [CI], 18.2 to 18.5) survived to discharge. The rate of survival did not change substantially during the period from 1992 through 2005. The overall incidence of CPR was 2.73 events per 1000 admissions; the incidence was higher among black and other nonwhite patients. The proportion of patients undergoing in-hospital CPR before death increased over time and was higher for nonwhite patients. The survival rate was lower among patients who were men, were older, had more coexisting illnesses, or were admitted from a skilled-nursing facility. The adjusted odds of survival for black patients were 23.6% lower than those for similar white patients (95% CI, 21.2 to 25.9). The association between race and survival was partially explained by hospital effects: black patients were more likely to undergo CPR in hospitals that have lower rates of post-CPR survival. Among patients surviving in-hospital CPR, the proportion of patients discharged home rather than to a health care facility decreased over time.
Conclusions Survival after in-hospital CPR did not improve from 1992 through 2005. The proportion of in-hospital deaths preceded by CPR increased, whereas the proportion of survivors discharged home after undergoing CPR decreased. Black race was associated with higher rates of CPR but lower rates of survival after CPR.
Source Information
From the Division of Pulmonary and Critical Care, Harborview Medical Center (W.J.E., J.R.C.), the Department of Epidemiology (W.J.E., T.D.K.), and the Comparative Effectiveness, Cost and Outcomes Research Center (W.K.) — all at the University of Washington, Seattle; the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh (A.E.B.); the Departments of Family Medicine and Medicine, Oregon Health and Science University, Portland (R.A.D.); and the Division of Pulmonary and Critical Care, University of Vermont, Burlington (R.D.S.).
Address reprint requests to Dr. Ehlenbach at the Harborview Medical Center, University of Washington, Box 359762, 325 Ninth Ave., Seattle, WA 98104, or at wje1{at}u.washington.edu.
Related Letters:
In-Hospital Cardiopulmonary Resuscitation
Wallace C. K., Brauner D. J., Grusin S. L., Ehlenbach W., Curtis J. R., Stapleton R.
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N Engl J Med 2009;
361:1708-1709, Oct 22, 2009.
Correspondence
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