If you were to have needed CPR, the best place you could be is in a hospital, right? Not exactly. A new study found that few people survive cardiac arrest after CPR, even in the hospital.
Out of the nearly half of a million (433,985) studied patients who underwent in-hospital CPR, less than one-fifth of them (18%) survived long enough to be discharged, according to a new study, "Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly," published in the July 2 issue of The New England Journal of Medicine.
A flat-lined improvement rate
Even worse, those numbers haven't improved since 1992. During the last decade, resuscitation outside of the hospital has improved chances of survival. With greater efforts in education and awareness, there have been better bystander intervention, more prevalent automatic defibrillators, more emergency-response CPR, and greater assistance from telephone dispatchers.
But the optimistic trend of outside CPR survival rates hasn't translated over to inside the hospital. The trend of survival rates at the hospital–where the best resources are available–have remained stagnant.
"The biggest take-home from this study is that the [in-hospital] survival rate hasn't improved," said Dana P. Edelson, MD, MS, hospitalist and director of clinical research for the Emergency Resuscitation Center at the University of Chicago Medical Center.
"The reason why the out-of-hospital survival rates are going up is because they were really bad [before]," said Edelson. Inside the hospital, "[r]esponse times and availability of equipment has always been better than outside of the hospitals so interventions that target those aspects such as bystander CPR and [automated external defibrillators], will not make an impact in the in-hospital setting," she said.
In fact, the odds are still in your favor to be in the hospital if you were to go into cardiac arrest. The in-hospital survival rate is 10–20%, while the out-of-hospital survival rate is 1–5%, according to Edelson.
Chances of survival
As for why only one-fifth of studied patients survive in-hospital resuscitation, people may simply be too sick.
"There are more people getting CPR than should be," said Edelson. "It's the default; most people expect CPR … but if you are sicker, older, and have lower chances of surviving, should it really be offered to you?" asks Edelson.
Race and resuscitation
Researchers also found a significant association between race and post-resuscitation survival. The study, which categorized race as white, black, and other, found that "the odds of survival were significantly lower for black and other nonwhite patients than for white patients," stated the study.
Even though black patients more often undergo CPR than white patients, the odds of black patients living long enough to walk out of the hospital are 24% less than their white counterparts.
Researchers also concluded that black patients may have more chronic illnesses and are less likely to choose do-not-resuscitate orders, which might account for the racial discrepancies. In addition, the hospitals in which black patients receive care also affect the odds.
"Nonwhite patients were more likely to receive care in hospitals where patients had lower odds of survival after CPR, regardless of their race," according to researchers in the study.
Beating the odds
With those sobering statistics for in-hospital survival rates that are static and associated with race, what can people do to beat the odds?
Edelson, a proponent of the hospitalist model leading resuscitation and patient care, said "You need a champion. Cardiac arrest is [an area] that is hard to have a champion. It's a bit of an orphan within the hospital, despite overlapping interests within cardiology, emergency medicine, and critical care."
The hospital can take the following steps to improve survival rates
- Increase use of do-not-attempt resuscitation orders in appropriate patients
- Implement, and then utilize, the rapid response team, to avoid preventable arrests
- Maximize resuscitation care by improving time to defibrillation and CPR quality
- Improve post-resuscitation care (hypothermia protocol for survivors)
To further add support, members in the C-suite can provide financial resources and support for the CPR committee and track data in the American Heart Association's National Registry of CPR, said Edelson.
The goal of the study was "not only to eliminate racial disparities in the quality of medical care but also understand factors associated with the incidence of CPR and the rate of survival after CPR for patients of all races," states the study.
Karen M. Cheung is associate editor at HCPro, Inc., and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.