Elsevier

Resuscitation

Volume 58, Issue 3, September 2003, Pages 297-308
Resuscitation

Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation

https://doi.org/10.1016/S0300-9572(03)00215-6Get rights and content

Abstract

The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an American Heart Association (AHA)-sponsored, prospective, multisite, observational study of in-hospital resuscitation. The NRCPR is currently the largest registry of its kind. The purpose of this article is to describe the NRCPR and to provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States. All adult (≥18 years of age) and pediatric (<18 years of age) patients, visitors, employees, and staff within a facility (including ambulatory care areas) who experience a resuscitation event are eligible for inclusion in the NRCPR database. Between January 1, 2000, and June 30, 2002, 14 720 cardiac arrests that met inclusion criteria occurred in adults at the 207 participating hospitals. An organized emergency team is available 24 h a day, 7 days a week in 86% of participating institutions. The three most common reasons for cardiac arrest in adults were (1) cardiac arrhythmia, (2) acute respiratory insufficiency, and (3) hypotension. Overall, 44% of adult in-hospital cardiac arrest victims had a return of spontaneous circulation (ROSC); 17% survived to hospital discharge. Despite the fact that a primary arrhythmia was one of the precipitating events in nearly one half of adult cardiac arrests, ventricular fibrillation (VF) was the initial pulseless rhythm in only 16% of in-hospital cardiac arrest victims. ROSC occurred in 58% of VF cases, yielding a survival-to-hospital discharge rate of 34% in this subset of patients. An automated external defibrillator was used to provide initial defibrillation in only 1.4% of patients whose initial cardiac arrest rhythm was VF. Neurological outcome in discharged survivors was generally good. Eighty-six percent of patients with Cerebral Performance Category-1 (CPC-1) at the time of hospital admission had a postarrest CPC-1 at the time of hospital discharge.

Sumàrio

O Registo Nacional de Reanimação Cardio-pulmonar (NRCPR) é um estudo observacional de reanimação intrahospitalar multicêntrico, prospectivo, patrocinado pela American Heart Association (AHA). O NRCPR é actualmente o maior registo do seu tipo. O objectivo deste artigo é descrever o NRCPR e proporcionar a primeira caracterização abrangente, baseada no modelo Utstein, da reanimação intrahospitalar nos Estados Unidos. Todos os doentes, visitantes, empregados e pessoal de uma instituição (incluindo áreas de cuidados ambulatórios), adultos (com idade igual ou superior a 18 anos) e pediátricos (idade inferior a 18 anos), que tenham sido alvo de reanimação foram elegı́veis para inclusão na base de dados NRCPR. Entre 1 de Janeiro de 2000 e 30 de Julho de 2002 ocorreram 14720 paragens cardı́acas, em adultos, de 207 hospitais participantes que cumpriram critérios de inclusão. Em 86% das instituições participantes está disponı́vel uma equipe de emergência organizada 24 horas por dia, 7 dias por semana. As 3 razões mais frequentes para paragem cardı́aca nos adultos foram: (1) arritmia cardı́aca, (2), insuficiência respiratória aguda e (3) hipotensão. Globalmente, 44% dos adultos vı́timas de paragem cardı́aca intrahospitalar tiveram retorno da circulação espontânea (ROSC); 17% sobreviveram até alta hospitalar. Apesar do facto de uma arritmia primária ser um dos eventos precipitantes em cerca de metade das paragens cardı́acas nos adultos, a fibrilhação ventricular (VF) foi o ritmo sem pulso inicial em apenas 16% das vı́timas de paragem cardı́aca intrahospitalar. Em 58% dos casos de VF ocorreu ROSC, resultando uma taxa de sobrevida até alta hospitalar de 34% neste subgrupo de doentes. Um desfibrilhador automático externo foi usado para administrar a desfibrilhação inicial em apenas 1,4% dos doentes em que o ritmo cardı́aco inicial de paragem foi VF. O resultado neurológico nos sobreviventes com alta foi na generalidade bom. Oitenta e seis por cento dos doentes com Categoria de Performance Cerebral–1 (CPC-1) no momento da admissão hospitalar tiveram CPC-1 pós-paragem no momento da alta hospitalar.

Resumen

El Registro Nacional de Resucitación cardiopulmonar (NRCPR) es un estudio prospectivo, multi institucional, observacional apoyado por la Asociación Americana del Corazón (AHA). El NRCPR es actualmente el registro más grande de este tipo. El propósito de este artı́culo es describir el NRCPR y proporcionar la primera caracterización estandarizada, basada en el estilo Utstein, del paro cardı́aco intra hospitalario en los Estados Unidos. Todos los pacientes, visitantes, empleados y personal de una instalación (incluyendo áreas de cuidados ambulatorios), adultos (≥18 años de edad) y niños (<18 años) que experimentaron un evento de resucitación son elegibles para la inclusión en la base de datos de la NRCPR. Entre el 1 de Enero, 2000 y el 30 de Junio, 2002, en los 207 hospitales participantes, ocurrieron 14720 paros cardı́acos en adultos que cumplieron los criterios de inclusión. En 86% de las instituciones participantes existe un equipo de emergencia organizado, disponible 24 horas al dı́a, 7 dı́as a la semana. Las 3 causas mas frecuentes de paro cardı́aco en adultos fueron (1) arritmia cardı́aca, (2) insuficiencia respiratoria aguda, y (3) hipotensión. Del total, 44% de los adultos vı́ctimas de paro cardı́aco presentaron retorno a circulación espontánea (ROSC); 17% sobrevivió al alta hospitalaria. A pesar del hecho que una arritmia primaria fue uno de los eventos precipitantes en casi la mitad de los paros cardı́acos en adultos, fibrilación ventricular (VF) fue el ritmo inicial sin pulso en solo 16% de las vı́ctimas de paro cardı́aco en adultos. Ocurrió ROSC en 58% de los casos de VF, alcanzando una tasa de sobrevida al alta de 34% en este sub grupo de pacientes. Solo en el 1.4% de los pacientes en quienes el ritmo inicial era VF se usó un desfibrilador automático externo para proporcionar la desfibrilación inicial. El resultado neurológico en los pacientes dados de alta vivos fue bueno en general. 86% de los pacientes con Categorı́a de Desempeño Cerebral-1 (CPC-1) al momento de admisión tenı́a CPC-1 al momento del alta.

Introduction

Several publications have reported the outcome of cardiopulmonary arrest in hospitalized patients over the past four decades. The majority of these reports are from single institutions, making generalization and meaningful comparisons difficult in the face of nonuniform data elements and definitions. To address this lack of standardization among patient, event, and outcome variables and to provide guidelines for the uniform reporting of hospital-based resuscitation events, in 1997 the International Liaison Committee on Resuscitation developed and published the Utstein style guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation [1]. These guidelines represent an international consensus on the processes that hospitals should use to collect and review data on adult and pediatric in-hospital resuscitations. They also provide a template for capturing all events for which resuscitation might be indicated. This systematic approach is vital to permit valid comparisons among hospitals and to track changes over time, both in single institutions and across the healthcare system as a whole [1], [2], [3], [4].

American Heart Association (AHA) volunteers from the disciplines of cardiology, emergency medicine, pediatric and adult critical care medicine, nursing administration, and nursing education drafted a model for a registry of in-hospital cardiopulmonary resuscitation. This model, which was based on the in-hospital Utstein guidelines, was given to the AHA and has evolved into the National Registry of Cardiopulmonary Resuscitation (NRCPR). Following software development and preliminary beta testing, the registry was launched on January 1, 2000. The NRCPR allows participating hospitals to track the characteristics, treatment, and outcomes of persons who develop cardiac arrest in the hospital. The registry is based on the Utstein in-hospital template.

The purpose of this article is to describe the NRCPR and provide the first comprehensive, Utstein-based, standardized characterization of in-hospital resuscitation in the United States.

Section snippets

Data collection

The NRCPR is an AHA-sponsored, prospective, multisite, observational study of in-hospital resuscitation. Although the number of hospitals enrolled in the NRCPR changes, this analysis includes medical/surgical hospitals that provided at least 6 months of data from January 1, 2000, through June 30, 2002. Participating hospitals join the NRCPR voluntarily and are charged an annual fee for data support and report generation. Participants are asked to characterize facilities, staff, patients, and

Hospital characteristics

A total of 207 (75 adult, 132 mixed adult and pediatric) hospitals submitted >6 months of in-hospital adult cardiac arrest data during the data collection period of January 21, 2000, through June 30, 2002. Participating hospitals had a median of 260 total beds (46% had <250 beds; 38%, from 250 to 499 beds; and 16%, >500 total beds) and a median of 20 ICU beds, defined by the NRCPR as any unit, including critical care unit and stepdown, with hardwired bedside monitoring (59% had <25 ICU beds;

Discussion

The NRCPR is currently the largest ongoing registry of in-hospital cardiopulmonary resuscitation. In its first 2 years, the number of cases in the registry dwarfed the number of cases previously reported by single institutions [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35] and groups of hospitals [36]. The closest counterpart of the NRCPR was the

Conclusions

The NRCPR is currently the largest multi-institutional, standardized database of in-hospital resuscitation events. It provides data on CPR process and outcome, allowing participants to evaluate their resuscitation performance critically in comparison with other institutions and to track secular trends over time. The registry provides important observational data that can be used by the AHA and other organizations to improve the base of evidence for future resuscitation guidelines and provide

Acknowledgements

The authors wish to thank the AHA, Dr Jerry Potts, Mr Michael C. Bell, and Mr Ted S. Borek, Jr., for their unwavering support in the development of the NRCPR; Tri-Analytics, Inc, especially Mr Scott Carey and Mr Ted Bemb, for providing technical and statistical management of the registry and data; and all participating NRCPR hospitals for helping to improve the process and outcomes of resuscitation in the hospital.

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