If you were to have needed CPR, the best place you could be is in a hospital, right? Not exactly. A new study found that few people survive cardiac arrest after CPR, even in the hospital.
Out of the nearly half of a million (433,985) studied patients who underwent in-hospital CPR, less than one-fifth of them (18%) survived long enough to be discharged, according to a new study, "Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly," published in the July 2 issue of The New England Journal of Medicine.
A flat-lined improvement rate
Even worse, those numbers haven't improved since 1992. During the last decade, resuscitation outside of the hospital has improved chances of survival. With greater efforts in education and awareness, there have been better bystander intervention, more prevalent automatic defibrillators, more emergency-response CPR, and greater assistance from telephone dispatchers.
But the optimistic trend of outside CPR survival rates hasn't translated over to inside the hospital. The trend of survival rates at the hospital–where the best resources are available–have remained stagnant.
"The biggest take-home from this study is that the [in-hospital] survival rate hasn't improved," said Dana P. Edelson, MD, MS, hospitalist and director of clinical research for the Emergency Resuscitation Center at the University of Chicago Medical Center.
"The reason why the out-of-hospital survival rates are going up is because they were really bad [before]," said Edelson. Inside the hospital, "[r]esponse times and availability of equipment has always been better than outside of the hospitals so interventions that target those aspects such as bystander CPR and [automated external defibrillators], will not make an impact in the in-hospital setting," she said.
In fact, the odds are still in your favor to be in the hospital if you were to go into cardiac arrest. The in-hospital survival rate is 10–20%, while the out-of-hospital survival rate is 1–5%, according to Edelson.
Chances of survival
As for why only one-fifth of studied patients survive in-hospital resuscitation, people may simply be too sick.
"There are more people getting CPR than should be," said Edelson. "It's the default; most people expect CPR … but if you are sicker, older, and have lower chances of surviving, should it really be offered to you?" asks Edelson.
Race and resuscitation
Researchers also found a significant association between race and post-resuscitation survival. The study, which categorized race as white, black, and other, found that "the odds of survival were significantly lower for black and other nonwhite patients than for white patients," stated the study.