Factors predicting outcome of cardiopulmonary resuscitation in a developing country: The Siriraj cardiopulmonary resuscitation registry

Abstract

Background: Outcomes of cardiac arrest and cardiopulmonary resuscitation (CPR) are not usually evaluated or monitored extensively in developing countries. Objective: To determine the outcome of CPR and the factors predicting its outcome. Material and Method: Siriraj Hospital is a 2,400-bed, 17-building, university hospital. Data were analyzed from the Siriraj CPR registry which was modified from the Utstein template. Data entry consisted of demographic data, reason for cardiac arrest, rhythm causing cardiac arrest, type of ward, type of department, status of patients before the event as well as sequence of action including the use of medications and outcome of CPR. The primary outcomes were rated to return of spontaneous circulation (ROSC) and survival to discharge. Univariate and multivariable logistic regression analysis were performed. Results: Approximately 95,000 patients were admitted to the hospital each year. There were a total of 2,747 CPR reports during the time frame from January 2003 to December 2006. Of these 57.9% were males. The average age was 53.3 ± 25.2 years. Most cardiac arrests occurred in the medicine, surgery and pediatric wards. Basic life support (BLS) was started within 1 minute in 83.1% and advanced life support (ALS) was started within 4 minutes in 78.6%. Of 516 (18.8%) patients were terminal cases. Outcomes of CPR were as follows: 49.8% had ROSC, 21% survived at 24 hours, and 7.4% survived to discharge. From a logistic regression analysis, predicting factors for both ROSC and survival to discharge included non-terminal cases, witnessed arrest, non-cardiac, non-sepsis causes, and arrest during daytime. Conclusion: The rate of ROSC and survival to discharge from the Siriraj CPR registry were 49.8% and 7.4% respectively. Several factors can be used to predict the immediate outcome of CPR. The present analysis should help monitor the quality of CPR and post-resuscitation care and aid in the strategic planning to improve CPR outcomes.