Cardiopulmonary Resuscitation in Critically 111 Neurologic-Neurosurgical Patients

Rabinstein, Alejandro A.; McClelland, Robyn L.; Wudicks, Eelco F. M.; Manno, Edward M.; Atkinson, John L. D.
November 2004
Mayo Clinic Proceedings;Nov2004, Vol. 79 Issue 11, p1391
Academic Journal
OBJECTIVES: To establish the rate of successful cardiopulmonary resuscitation (C PR) and to study outcome predictors in patients who experienced In-hospital cardiac arrest after being admitted to the neurologic-neurosurgicai intensive care unit (ICU) with a primary neurologic diagnosis. PATIENTS AND METHODS: We identified patients admitted to the neurologic-neurosurgical ICU between 1994 and 2001 who experienced in-hospital cardiac arrest and received CPR. Functional outcome was assessed using the modified Rankin scale. RESULTS: During the study period, 38 consecutive patients experienced in-hospital cardiac arrest and received CPR. The median age of the patients was 65 years (range, 16-81 years), and the mean interval from admission to CPR was 12 days (range, 3 hours to 47 days). Acute Intracranial disease was present in 32 patients (84%). Twenty-one patients (55%) were in the ICU at the time of the cardiac arrest; cardiac arrests In the wards occurred at a mean Interval of 9 days (range, 1-45 days) after CU discharge. Cardiopulmonary resuscitation achieved return of spontaneous circulation in 23 patients (61%). Seven patients (18%) were discharged from the hospital, 5 of whom later achieved a modified Rankin scale score of 2 or lower. Cardiac arrest after a deteriorating clinical course resulted In uniformly fatal outcomes. Duration of CPR shorter than 5 minutes and CPR In the ICU were associated with survival and good functional recovery. CONCLUSIONS: Cardiopulmonary resuscitation is a worthwhile procedure In severely III neurologic-neurosurgical patients, regardless of the patient's age. However, the outcome after CPR appears much worse In patients with a prior deteriorating clinical course.


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