Predicting survival from in-hospital CPR

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Abstract
Objective: To better clarify patient factors that predict survival from in-hospital cardiopulmonary resuscitation (CPR), using two methods: 1) meta-analysis and 2) validation of a prediction model, the pre-arrest morbidity (PAM) index. Design: Meta-analysis of previously published studies by standard techniques. Retrospective chart review of validation sample. Setting: University-affiliated teaching hospital. Patients/participants: Meta-analytic sample of 21 previous studies from 1965–1989. The validation sample consisted of all patients surviving resuscitation from the authors’ hospital during the period September 1986 to January 1991. A matched sample of patients who did not survive from the same time period was used as the comparison group. Interventions: None. Measurements and main results: The strongest negative predictors of survival, by meta-analysis, were renal failure (r=0.088, p2=9.6%). No patient who survived to discharge had a PAM score higher than 8. Conclusion: Meta-analysis reveals that the most significant negative predictors of survival from CPR are renal failure, cancer, and age more than 60 years, while AMI is a significant positive predictor. The PAM index is a useful method of stratifying probability of survival from CPR, especially for those patients with high PAM scores, who have essentially no chance of survival.