In-Hospital Cardiac Arrest: Predictors Of Long Term Survival After Being Discharged Alive

Background Long term survival of patients discharged alive after cardiopulmonary resuscitation (CPR) for an in-hospital cardiac arrest (IHCA) has not been extensively studied. It is also largely unknown which of these patients are at high risk for poor survival. Therefore we studied survival and predictors of survival for these patients. Methods We retrospectively studied patients who suffered from an IHCA between 1997–2004 and who survived to discharge. Data were collected using an Utstein form. A Kaplan Meier curve was calculated for survival. Survivors were compared with non-survivors and Cox regression analysis was performed to determine predictors of survival. Results In this period 222 patients had an IHCA and 19% (n=42) was discharged alive. Known predictors of survival to discharge were confirmed, primarily initial rhythm. In the discharged patients, survival after a median follow-up of 2.9 years (IQR 1.5–7.2) was 57% (n=24). Non-survivors were significantly older, median age 69.3 (IQR 59.6 –75.2) versus 56.7 (IQR 48.1– 68.8) years and had significantly more often diabetes mellitus, arrhythmias, valvular disease and cancer in their medical history than survivors. Initial rhythm did not differ between groups. After adjustment for baseline differences it was found that cancer independently predicted a lower chance of survival (HR 2.8; 95% CI 1.1–7.5). Older age tended to predict a lower chance of survival as well. Conclusion Whenever a patient is discharged alive after an IHCA, the chance of survival is evidently reduced. Only cancer independently predicted a lower chance of survival. Long term survival seems to be determined more by comorbidity than arrest variables.