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CPR More Effective Than Assumed in Hospitals
Respiratory failure, shock more common causes of
cardiac arrest than arrhythmias
Jan. 5, 2006 – In the most comprehensive study ever
of cardiac arrests occurring in U.S. hospitals, it was found that
appropriate cardiopulmonary resuscitation (CPR) is producing survival
rates much higher than assumed. The study also found that respiratory
failure and shock are much more common causes of in-hospital cardiac
arrests than sudden arrhythmias.
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Children given CPR are more likely to survive
in-hospital cardiac arrests than adults but the survival rates for both
are higher than previously thought, according to the study supervised by
Robert A. Berg, MD, professor of pediatrics and associate dean at The
University of Arizona College of Medicine.
With appropriate interventions, more than 27
percent of the children and more than 18 percent of the adults who had
no pulse with cardiac arrest survived to hospital discharge, mostly with
good neurological outcomes, the study says.
"This is a landmark study that will change our
understanding of the causes for cardiac arrests in hospitals and how to
treat them," said Dr. Berg, a member of UA's Sarver Heart Center and
UA's Steele Children's Research Center.
"Many physicians assume that the vast majority of
adult cardiac arrests in hospitals are from sudden arrhythmias. Our
findings show that respiratory failure and shock are much more common
causes of in-hospital cardiac arrests than arrhythmias in both adults
and children."
In contrast to previous studies, which compiled
data from a single or relatively few hospitals, the new research is
based on data from the National Registry of CPR including 37,000 adults
and 880 children who had pulseless cardiac arrests in the hospital.
The National Registry of CPR was developed by the
American Heart Association to compile comprehensive and accurate
information about in-hospital cardiac arrests. The investigators
collected data from 253 hospitals in the United States and Canada
between 2000 and 2004.
"For the first time, we have data representing all
of the United States instead of a snapshot focusing on a particular
region or patient group," said Dr. Berg.
The study results are published in the Jan. 4 issue
of the Journal of the American Medical Association.
"Nobody ever imagined that such a high percentage
of lifeless children could be successfully resuscitated and leave the
hospital alive," Dr. Berg said.
"These survival rates are much better than those
occurring in cardiac arrests outside of hospitals," said Vinay Nadkarni,
MD, a critical care specialist at the Children's Hospital of
Philadelphia, and the lead author of the study. "This suggests that CPR
currently may succeed more often than physicians commonly believe."
The American Heart Association recently issued new
guidelines for CPR and emergency cardiovascular care.
Broad-based comprehensive studies through the
National Registry of CPR will provide important information for future
guidelines, especially with regard to in-hospital cardiac arrests. The
Emergency Cardiovascular Care Committee of the American Heart
Association and the Endowed Chair of Pediatric Critical Care at The
Children's Hospital of Philadelphia funded this study.
The 11 co-authors, writing for the National
Registry of CPR Investigators, were from nine hospitals and research
institutions and represented the research committee of the Scientific
Advisory Board of the registry.
"The National Registry of CPR will allow us to
track possible improvements in patient outcomes stemming from the new
guidelines, and should help us to refine future revisions to AHA
guidelines," said Dr. Berg, who chairs the research committee.
By better understanding ways in which children with
in-hospital cardiac arrest may sometimes resemble and sometimes differ
from adults, practitioners may be able to better refine emergency
cardiovascular care and develop treatment procedures that improve
outcomes for all patients.
Reference:
First Documented Rhythm and Clinical Outcome From In-Hospital Cardiac
Arrest Among Children and Adults. JAMA, Jan. 4, 2006 -- Vol. 295, No. 1,
pp.1-8
Websites:
Sarver Heart Center:http://heart.arizona.edu
Steele Children's Research Center:
http://www.steelecenter.arizona.edu
American Heart Association:
http://www.americanheart.org
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