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Arquivos Brasileiros de CardiologiaResumo das Próximas PublicaçõesAno 2001
Prognostic Factors of the Results of Cardiopulmonary Resuscitation in a Cardiology HospitalAri Timerman, Naim Sauaia, Leopoldo Soares Piegas, Rui F. Ramos, Elizabeth Silva Santos, Antonio C. Mugayar Bianco, J. Eduardo M. R. Sousa
Objective - To analyze the early and late results of cardiopulmonary resuscitation (CPR) in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. Methods - A series of 557 patients who suffered cardiorespiratory arrest (CRA) at the Dante Pazzanese Cardiology Institute (DPCI) over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. Results - Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients; 281 patients (52.4%) died immediately, and 164 patients (30.6%) survived for than 24 hours. The characteristics of those 87 patients who survived for more than 1 month after CRA were compared with those of nonsurvivors. Coronary heart disease, cardiomyophathy, and valvular heart disease had a better prognosis when compared with other diseases. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation (VF), 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived for more than 1 month. None of the 10 patients with CRA in electromechanical dissociation (EMD) survived. Our series demonstrated a poorer prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more). Regarding the location of the arrest, we obtained better results when the cardiac arrest occurred in the cardiac catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. Conclusion - Our findings, therefore, show higher resuscitation success and long-term survival rates in those patients included in 1 of the following categories: age between 11 and 69 years, CRA occurring in cardiac catheterization laboratories, coronary artery disease, cardiomyopathy, or valvular heart disease as the underlying disease, primary arrhythmia as the determinant cause, and VF as the initial mechanism of CRA. The worst results occurred in those patients aged between zero and 10 years or >70 years; CRA occurring in the hemodialysis room or intensive care unit with the underlying disease being cyanotic congenital heart disease, chronic renal failure, or chronic cor pulmonale; heart failure, stroke, or an anoxic spell being the determinant cause; and ventricular asystole or EMD being the initial mechanism of CRA. In the multivariate statistical analysis, only underlying disease, CRA determinant cause, and initial mechanism were statistically significant. The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts. Key words:, cardiorespiratory arrest, acute myocardial infarction
Instituto Dante Pazzanese de Cardiologia Mailing address: Ari Timerman – Rua Pará, 90/71 – 01243-120 São Paulo, SP – Brazil E-mail: timerman@originet.com.br
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