Prognosis of Cardiopulmonary Resuscitation (CPR)

00:01 It's important when you're thinking about CPR and how you're going to discuss this with patients and families that prognosis of CPR and, you know, what happens afterwards after a cardiac arrest of whether or not it's going to be successful.

00:19 And there are three ways to think about prognosis.

00:22 There's immediate survival after the CPR attempt, so, do you restore the heart and the breathing? There's survival to hospital discharge.

00:33 So, maybe right after the arrest, you've brought the person back but they actually don't survive to leave the hospital.

00:41 And then, the third way to think about prognosis is survival with intact neurologic function.

00:46 So, in that period of time where they were getting hypoxic or, you know, anoxic because they weren't having any kind of circulation, did they suffer any neurologic consequence as a result of that? Some brain injury from the hypoxia.

01:03 And there are going to be two things that are going to be important in thinking about whether or not the CPR is going to be successful.

01:12 There may be CPR factors themselves, but also, patient factors that will confer whether or not there's going to be a good or poor prognosis.

01:21 So, let's look a little bit closer at the factors with regard to the resuscitation efforts themselves.

01:27 So, whether it's in hospital or out of hospital. If it's out of hospital in the community and the person suffers a cardiac arrest, much more likely that the person will not survive the cardiac arrest because you haven't been able to institute CPR immediately.

01:45 Whether it's witnessed or unwitnessed.

01:47 Obviously, if it's unwitnessed and then, someone comes along and finds the person unconscious without pulse or breathing, much more likely that they will not survive a CPR attempt at that point as opposed to when they - when it's been witnessed and someone is able to intervene right away.

02:06 The time to initiation of the CPR will matter.

02:09 So, if it's done as quickly as possible, you start CPR and chest compressions and so on, better chance of survival than if you delay the initiation of the CPR.

02:22 What cause the cardiac arrest to a matter? So, if the initial rhythm is ventricular fibrillation or ventricular tachycardia, much more likely that the CPR efforts will be successful than if it were asystole or pulsus electrical alternans.

02:39 And because, you know, the fibrillation, the ventricular fibrillation might speak to whether or not there's a, you know, good or bad prognosis, it's how quickly can you defibrillate, get them out of that abnormal rhythm. The quicker that's done, the better the prognosis.

02:57 And then, you know, as you're doing all these efforts, it's the time that it takes to return to spontaneous circulation, what we call the ROSC.

03:07 The quicker that's done, the better the chance of the survival of the patient.

03:13 And how long you need to do the resuscitation will also bear on prognosis.

03:19 So, the longer it takes, the worse the outcome will be.

03:23 If you're able to restore new spontaneous circulation relatively quickly, defibrillate to get them out of the abnormal rhythm, do that all quickly, better chance that the person's going to survive.

03:37 There are going to be patient factors that also bear on prognosis.

03:41 I'm going to go through a few that will mean that it's actually a worse prognosis, much more likely that the patient will die as a result of the cardiac arrest than that the resuscitation efforts will be successful.

03:54 So, a patient that's undergone major trauma, you know, so, a car accident or, you know, a battlefield scenario, you know, significant damage to the body, unlikely that you're going to be able to restore circulation and breathing.

04:11 A patient that's had an acute stroke, if they suffer cardiac arrest in the midst of that acute stroke, the literature shows that there's a worse prognosis there.

04:21 Patients with either metastatic or hematologic cancers, really the, you know, cardiac arrest at that point is maybe more a reflection of the advancement of their cancer and their body shutting down than it is that there's anything that is reversible with their cardiac condition.

04:41 Sepsis also confers a worse prognosis. So, a person that might be, you know, hypotensive as a result of being septic.

04:51 And then, you know, their heart stops in that situation, much more unlikely that cardiac arrest will be successful or cardiac pulmonary resuscitation will be successful.

05:03 If a person has multiple comorbidities, it's not, you know, a primary cardiac problem but other non-cardiac issues, and they've been sick, you know, from a result of all those comorbidities, also unlikely that they would survive the CPR.

05:20 The literature shows that, you know, liver failure in particular, so, that end organ failure also confers a worse prognosis in CPR.

05:31 When the, you know, studies have been done that's also shown that patients that are admitted from a skilled nursing facility, sort of already a reflection that they are physically weakened, they might also have less of a chance of survival of cardiopulmonary resuscitation.

05:51 And also, the older individuals, if your age is greater than 80 years old, that also confers a worse prognosis.