Penelope Evagelopoulou

Efficacy of CPR in a general, adult ICU

AIM To investigate the initial cardiopulmonary resuscitation (CPR) success rate and long term survival in an Intensive care unit (ICU) population. PATIENTS All patients with cardiac arrest over a 2-year-period (1999-2000) in a general, adult ICU of a general hospital of Athens. METHODS Retrospective collection of clinical data concerning patients, CPR characteristics and survival rates. RESULTS We examined 111 ICU patients, aged 56.4+/-1.9 years (72 males). SAPS II score was 43.9+/-3.8. CPR was performed in 98.2% of the patients within 30 s. Initial restoration of cardiac function (RCF) and successful CPR rate was 100% while 24 h survival was 9.2%. Survivors at 24 h were younger, mainly males, with lower SAPS II score, mainly with pulmonary disease, ventricular fibrillation or ventricular tachycardia (8/10) and initial pupil reactivity (5/10). Four patients required more than one cycle of CPR. Survival to discharge was zero. CONCLUSION Although the initial successful CPR rate in ICU patients may be high, long term survival and hospital discharge is disappointing. Although ICU patients are better monitored and treated in a timely fashion, they are disadvantaged by chronic underlying diseases, severe current medical illnesses and multi organ dysfunction syndrome (MODS) leads to worst outcome after CPR compared with in-ward patients.

Mechanical ventilation and the immune response

We found no statistically significant increase (paired sample t test) in the supernatant of tracheal aspirates between baseline and 2 h after MV for tumor necrosis factor (TNF) α, interleukin (IL) 6, IL-10, TNF-RI and TNF-RII concentrations (Table 1, Fig. 1). TNF-α, TNF-RI, and TNF-RII concentrations in serum were also not significantly altered after 2 h of MV (Fig. 2). On the other hand, there was a statistically significant increase in mean serum concentrations of IL-6 and IL-10. However, examining individual data, only two patients undergoing abdominal surgery (colectomy and appendecectomy) showed a significant increase in these cytokines. Our findings do not confirm in general that MV can significantly alter immune response [1] either locally in the lungs or systematically in the circulation in adult patients without preexisting lung disease undergoing MV for elective surgery. However, there is evidence in two patients of systematic alterations in immune response, both proand anti-inflammatory, which can be attributed to surgical manipulations. Our findings do not confirm the findings either Intensive Care Med (2002) 28:1365–1366 DOI 10.1007/s00134-002-1425-0 C O R R E S P O N D E N C E