Ballew K A, Philbrick J T, Caven D E, Schorling J B
Department of Medicine, University of Virginia School of Medicine, Charlottesville.
Arch Intern Med. 1994 Nov 14;154(21):2426-32.
Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR.
The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics.
Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older.
The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of in-hospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.
向患者咨询院内心肺复苏（CPR）的风险和益处可能会减少患者痛苦并降低医院成本。然而，目前对于院内心肺复苏的总体生存率以及识别更有可能或不太可能从心肺复苏中存活的患者特征存在很大分歧。
回顾了1990年和1991年在一家拥有720张床位的大学医院接受基本心肺复苏的所有无脉成年患者的病历。如果心脏骤停发生在医院外、急诊科、手术室、恢复室或心导管实验室，则将患者排除。查阅每位患者的病历以确定是否存在明确界定的临床特征。
总体而言，313名患者中有50名（16.0%）存活至出院。心脏骤停前，只有功能能力受损和脓毒症可识别出不太可能从心肺复苏中存活的患者。在研究期间发生心脏骤停的成年人中，只有22%接受了心肺复苏，其中癌症患者为13.0%，70岁及以上患者为18.1%。
使用“不要复苏”医嘱排除不适合进行心肺复苏的患者，可能解释了为何本研究报告的生存率高于类似报告，以及为何未发现更多临床特征可预测心肺复苏的存活情况。院内心肺复苏的研究人员应使用明确标准来描述所研究的情况，并报告接受基本心肺复苏患者的生存率。必须考虑“不要复苏”医嘱对生存率的影响。功能能力作为心肺复苏存活的预测指标值得进一步研究。
