Descriptive analysis of the in-hospital course of patients who initially survive out-of-hospital cardiac arrest but die in-hospital

Objective: To describe the postresuscitative hospital course of emergency department patients who initially survive nontraumatic out-of-hospital cardiac arrests (OOHCA) but die in the hospital. Methods: A 12-month case series of all nontraumatic OOHCA patients at two large urban Midwestern teaching hospitals who survived to hospital admission but died before discharge. Medical records from identified patients were reviewed for demographics, resuscitation sequelae, do-not-attempt-resuscitation (DNAR) code status, pain declarations, and withdrawal of life support. Descriptive statistics are reported. Results: Between August 31, 2005 and July 31, 2006, there were 468 nontraumatic OOHCA patients treated at the study hospitals. Forty-one (8.8%) patients initially survived and were admitted to the hospital, of whom 32 (78.0%) expired before hospital discharge. Pain declarations were noted in 8 (25.0%) patients, of whom 4 had more than one assessment. Median postresuscitation survival time was 1.5 days (range, 9.3 hours to 18.6 days). Overall, 19 (59.4%) patients died after withdrawal of life support, 8 (25.0%) while actively on life support, and 5 (15.6%) died with subsequent cardiopulmonary resuscitation (CPR). Possible complications of CPR included pneumothorax in 2 (6.3%) and intracranial hemorrhage in 1 (3.1%). Conclusions: In this urban setting, approximately three of four OOHCA patients who are initially resuscitated do not survive to hospital discharge. This short in-hospital course post-CPR is often marked by pain and ends with the withdrawal of life support. This information may be an important component of advance planning discussions and may assist patients as they weigh the pros and cons associated with resuscitation preferences.