Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results

Abstract

Objective: To determine the circumstances, incidence, and outcome of cardiopulmonary resuscitation in British hospitals.

Design: Hospitals registered all cardiopulmonary resuscitation attempts for 12 months or longer and followed survival to one year.

Setting: 12 metropolitan, provincial, teaching, and non-teaching hospitals across Britain.

Subjects: 3765 patients in whom a resuscitation attempt was performed, including 927 in whom the onset of arrest was outside the hospital.

Main outcome measure: Survival after initial resuscitation, at 24 hours, at discharge from hospital, and at one year, calculated by the life table method.

Results: There were 417 known survivors at one year, with 214 lost to follow up. By life table analysis for every eight attempted resuscitations there were three immediate survivors, two at 24 hours, 1.5 leaving hospital alive, and one alive at one year. Survival at one year was 12.5% including out of hospital cases and 15.0% not including these cases. Each hospital year averaged 30 survivors at one year: three who had an arrest outside hospital, seven who had one in the accident and emergency department, seven in the cardiac care unit, 10 in the general wards, and three in other, non-ward areas. Within the hospitals survival rates were best in those who had an arrest in the accident and emergency department, the cardiac care unit, or other specialised units. Outcome varied 12-fold in subgroups defined by age, type of arrest, and place of arrest.

Conclusion: 71% of the mortality at one year in patients undergoing attempted resuscitation occurred during the initial arrest. Hospital resuscitation is life saving and cost effective and warrants appropriate attention, training, coordination, and equipment.