BACKGROUND: There are many factors affecting successful cardiopulmonary resuscitation. One is the patient's characteristics which includes age, sex, and comorbidities. Likewise, the quality of the resuscitation which is dependent to the latest guideline set by international medical specialist organization like American Heart Association and the very people conducting the resuscitation have large impact in the outcome. The objective of this study is to determine the factors affecting the outcome of cardiopulmonary arrest patients in our own local setting.
METHODOLOGY: Patients admitted in PHC who were more than 18 years old and had cardiopulmonary arrest (CPA) and was administered with ACLS by the Philippine Heart Center Medical Emergency Event (PHC MET) team was included in the study. Patients with "Do Not Resuscitate" (DNR) status, before and during the first arrest and CPA at the emergency room or operating room were excluded. All data from eligible patients received ACLS from July 2010 to June 2011 were retrieved and reviewed. Patient who were successfully resuscitated were categorized to group 1 and were followed up during the hospital stay to determine outcome on discharge. Patients who were unsuccessfully resuscitated or who had death were categorized to group 2. Pre-arrest and arrest variables were recorded d analyzed between two groups.
RESULTS: One hundred seventy-five (175) patients from January to December 2010 were enrolled in the study. 102 patients who were successfully resuscitated were categorized under revived group (Group 1) and 73 patients who expired despite CPR were categorized under the mortality group(Group 2). Baseline characteristics between two groups were similar except for the presence of diabetes which was noted to be statistically significant in the the mortality group. There were 92 patients under the cardiac group and 83 patients under the non-cardiac group. More patients arrested in the ward for group 1 (60%) and critical care unit in group 2 (61%). There is no predilection between duty and off-duty hours in both groups (46% vs. 54% and 47% vs. 57% respectively. Arrhythmia was shown to be significantly associated with unsuccessful resuscitstion (p<0.001) in the cardiac group. Asystole/PEA was noted to be the most common initial ECG n arrest for the two groups. (69% and 77%). More than 90% of cases, the MET team arrived within one minute time. CPR duration of more than 30 minutes significantly was associated with mortality both groups. (p<0.001). Only 27 patients were discharged after CPR. 32 (43%) patients expired, 42 (56%) signed for a DNR status and one (1%) decided for discharged against medical advice. Among these patients who eventually expired, the non-cardiac cases were significantly associated with mortality compared with the cardiac group (p=0.001).
CONCLUSION: The presence of diabetes is significantly associated with unsuccessful resuscitation in cardiopulmonary arrest patients. However, we cannot ignore t other factors such as age, smoking and alcohol history, and other comorbidities plays a major influence in the outcome of CPR which was not shown in this study. The site and timing of the arrests and the category of the patient does not affect the outcome. The PHC MET team arrived on time. Prolong of CPR of more than 20 minutes was significantly associated with mortality, and thus, we can consider terminating resuscitative effort to ease the burden of both the family and medical team specifically if the prognosis if poor.
KEYWORDS: Cardiopulmonary resuscitation, cardiopulmonary arrest, In-hospital survival, PHC Medical Emergency Event Team