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CRITICAL CARE AND TRAUMA

Outcomes of Cardiopulmonary Resuscitation and Predictors of Survival in Patients Undergoing Coronary Angiography Including Percutaneous Coronary Interventions

Juraj Sprung, MD, PhD^*, Matthew J. Ritter, MD^*, Charanjit S. Rihal, MD, Mary E. Warner, MD^*, Gregory A. Wilson, CCRP^*, Brent A. Williams, MS, Susanna R. Stevens, BS, Darrell R. Schroeder, MS, Denis L. Bourke, MD, and David O. Warner, MD^*

*Department of Anesthesiology, Department of Medicine, and Division of Biostatistics, Mayo Clinic, Rochester, MN; Anesthesiology Service Baltimore VAMC and the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland

Address correspondence and reprint requests to Juraj Sprung, MD, PhD, Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905. Address e-mail to sprung.juraj{at}mayo.edu.

We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary artery bypass graft surgery, hemodynamic instability during the procedure, and with prolonged or emergent catheterizations. Pulseless electrical activity (versus asystole or ventricular fibrillation) indicated very poor short-term survival. Interestingly, short-term survival was not related to the extent of coronary artery disease. Long-term survival of patients who survived cardiac arrest was comparable to that of those who did not have arrest during catheterization. In conclusion, the incidence of periprocedural CPR during diagnostic or interventional coronary procedures decreased after 1995. Patients who received CPR in the cardiac catheterization lab have a remarkably frequent survival to hospital discharge rate. Long-term survival of these patients is only minimally reduced.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999