Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA.
Fam Pract. 2011 Oct;28(5):505-15. doi: 10.1093/fampra/cmr023. Epub 2011 May 18.
Our objective was to perform a systematic review of pre-arrest predictors of the outcome of in-hospital cardiopulmonary resuscitation (CPR) in adults.
We searched PubMed for studies published since 1985 and bibliographies of previous meta-analyses. We included studies with predominantly adult patients, limited to in-hospital arrest, using an explicit definition of cardiopulmonary arrest and CPR and reporting survival to discharge by at least one pre-arrest variable. A total of 35 studies were included in the final analysis. Inclusion criteria, design elements and results were abstracted in parallel by both investigators. Discrepancies were resolved by consensus.
The rate of survival to discharge was 17.5%; we found a trend towards increasing survival in more recent studies. Metastatic malignancy [odds ratio (OR) 3.9] or haematologic malignancy (OR 3.9), age over 70, 75 or 80 years (OR 1.5, 2.8 and 2.7, respectively), black race (OR 2.1), altered mental status (OR 2.2), dependency for activities of daily living (range OR 3.2-7.0 depending on specific activity), impaired renal function (OR 1.9), hypotension on admission (OR 1.8) and admission for pneumonia (OR 1.7), trauma (OR 1.7) or medical non-cardiac diagnosis (OR 2.2) were significantly associated with failure to survive to discharge; cardiovascular diagnoses and co-morbidities were associated with improved survival (range OR 0.23-0.53). Elevated CPR risk scores predicted failure to survive but have not been validated consistently in different populations.
We identified several pre-arrest variables associated with failure to survive to discharge. This information should be shared with patients as part of a shared decision-making process regarding the use of do not resuscitate orders.
我们的目的是对成人院内心肺复苏（CPR）结局的预警指标进行系统评价。
我们在 PubMed 上检索了自 1985 年以来发表的研究，并查阅了先前荟萃分析的参考文献。我们纳入了主要纳入成人患者、仅限于院内停搏、使用明确的心肺骤停和 CPR 定义以及至少报告一项预警指标出院存活率的研究。共有 35 项研究纳入最终分析。两名研究者同时提取纳入标准、设计要素和结果。通过共识解决分歧。
出院存活率为 17.5%；我们发现近期研究的存活率呈上升趋势。转移性恶性肿瘤[比值比（OR）3.9]或血液系统恶性肿瘤（OR 3.9）、年龄＞70、75 或 80 岁（OR 1.5、2.8 和 2.7）、黑种人（OR 2.1）、精神状态改变（OR 2.2）、日常生活活动依赖（具体活动的 OR 范围为 3.2-7.0）、肾功能不全（OR 1.9）、入院时低血压（OR 1.8）、肺炎入院（OR 1.7）、创伤（OR 1.7）或非心脏疾病诊断（OR 2.2）与未存活至出院显著相关；心血管疾病诊断和合并症与存活率提高相关（OR 范围为 0.23-0.53）。升高的 CPR 风险评分预测无法存活，但在不同人群中并未得到一致验证。
我们确定了一些与未能存活至出院相关的预警指标。这些信息应与患者共享，作为关于不复苏医嘱使用的共同决策过程的一部分。
