The effect of the APACHE II score and selected clinical variables on survival following cardiopulmonary resuscitation.

BACKGROUND AND OBJECTIVES

The purpose of this analysis is to determine the effect of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and other clinical variables on survival following cardiopulmonary resuscitation (CPR) and to identify patient subpopulations with extremely poor survival.

METHODS

A retrospective chart review was performed on 218 consecutive adult inpatients undergoing CPR on the general wards and in the intensive care units of a community hospital between January 1, 1989, and July 1, 1991. The patient's age, sex, prior residence, reason for admission, discharge diagnoses, discharge disposition, APACHE II score, and cardiac ejection fraction by echocardiography were recorded.

RESULTS

The age, sex, and reason for admission were not significant predictors of survival following CPR. Multiple variable analysis revealed that an increasing APACHE II score (P = .05), a serum creatinine greater than 311 mumol per L (3.5 mg per dL, P = .02), and metastatic cancer (P = .04) were each related to a decreased rate of survival to discharge following CPR. Patient subpopulations with a 0% rate of survival to discharge included those with metastatic cancer (n = 26, P = .02), a serum creatinine greater than 311 mumol per L (3.5 mg per dL) on admission (n = 22, P = .03), and a diagnosis of cardiovascular disease with an APACHE II score greater than 15 on admission (n = 18, P = .007).

CONCLUSIONS

The APACHE II score is a useful predictor of failure to survive to discharge following CPR. Several groups of patients were identified with negligible rates of survival to discharge. Physicians should use such prediagnostic information to provide patients with informed consent when discussing do-not-resuscitate (DNR) orders. We suggest that physicians make a special effort to address the DNR status of patients falling to one of the negligible-survival groups identified by this study.