Predicting survival from in-hospital CPR: meta-analysis and validation of a prediction model.
J Gen Intern Med
; 8(7): 347-53, 1993 Jul.
Article
em En
| MEDLINE
| ID: mdl-8410394
ABSTRACT
OBJECTIVE:
To better clarify patient factors that predict survival from in-hospital cardiopulmonary resuscitation (CPR), using twomethods:
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 MAINRESULTS:
The strongest negative predictors of survival, by meta-analysis, were renal failure (r = 0.088, p < 0.0002), cancer (r = 0.08, p < 0.0002), and age more than 60 years (r = 0.063, p < 0.006). Sepsis (r = 0.046, p < 0.02), recent cerebrovascular accident (CVA) (r = 0.038, p < 0.04), and congestive heart failure (CHF) class III/IV (r = 0.036, p < 0.05) were weaker negative predictors. Presence of acute myocardial infarction (AMI) was a significant positive predictor of survival (r = 0.15, p < 0.0001). The PAM score was highly predictive of survival in a logistic regression model (p < 0.0003, R2 = 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.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Taxa de Sobrevida
/
Mortalidade Hospitalar
/
Reanimação Cardiopulmonar
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
1993
Tipo de documento:
Article
País de publicação:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA