What percent of adult patients with pre-existing medical conditions, such as coronary artery disease (CAD), heart failure, or chronic obstructive pulmonary disease (COPD), discharge home after cardiopulmonary resuscitation (CPR) in a hospital?

In-Hospital Cardiac Arrest Survival to Discharge

Approximately 22-26% of adult patients survive to hospital discharge after in-hospital CPR, with the majority (82%) of survivors maintaining good functional status. 1

Current Survival Data

The most recent American Heart Association guidelines (2020) report that 25.8% of adults who suffer in-hospital cardiac arrest (IHCA) are discharged alive, representing significant improvement from historical rates. 1 This contrasts sharply with out-of-hospital cardiac arrest, where only 10.4% survive to discharge. 1

Key Survival Metrics by Setting:

• Overall in-hospital survival: 22.3-25.8% to discharge 1
• Functional outcomes: 82% of survivors have good neurological status (CPC 1-2) at discharge 1
• ICU-specific survival: Approximately 15.7% survive to discharge after in-ICU CPR 2

Factors Influencing Survival

Initial Cardiac Rhythm

Survival varies substantially based on presenting rhythm 3:

• Ventricular fibrillation/pulseless VT: 34% survival 3
• Pulseless electrical activity: 38% survival 3
• Asystole: 24% survival 3

Location of Arrest

Most in-hospital arrests occur in monitored settings where outcomes are optimized 1:

• ICU arrests: 48% of all in-hospital CPR events 1
• General wards (unmonitored): 19% of events 1
• Emergency departments/procedural areas: 18% of events 1

The concentration of arrests in ICUs reflects both patient acuity and the availability of immediate advanced interventions. 1

Patient-Specific Prognostic Factors

Poor prognostic indicators include 4, 5, 6:

• Age >60-70 years with multiple comorbidities 5, 6
• Sepsis (only 1 of 39 septic patients survived in one study) 4
• Active malignancy (only 1 of 29 cancer patients survived) 4
• End-stage renal disease, chronic liver disease 4
• CPR duration >10-15 minutes 5, 6
• Initial PO₂ <50 mmHg during resuscitation 6

Functional Outcomes Among Survivors

A critical caveat: While 25.8% survive to discharge, functional morbidity is substantial. 2 Among ICU CPR survivors:

• Only 33.6% are discharged home 2
• Only 20.1% are functionally independent at discharge 2
• 63.4% experience decreased functional status compared to admission 2
• Only 3.3% of all patients (21.7% of survivors) achieve "optimal" outcome (functionally independent AND discharged home) 2

Temporal Trends

Survival has improved significantly over time. Risk-adjusted survival rates increased by 4% per year from 2000-2009, rising from 13.7% to 22.3%. 1 This improvement reflects systematic quality improvement initiatives and better implementation of the Chain of Survival. 1

Quality Disparities

Important pitfall: Substantial variability exists between hospitals. 1 Case-mix-adjusted survival rates show:

• Top decile hospitals achieve nearly double the survival of bottom decile hospitals 1
• A 42% difference in survival likelihood exists between randomly selected hospitals for identical patients 1
• Weekend and nighttime arrests have significantly lower survival rates, suggesting differential quality of care 1

Special Populations

For patients with chronic progressive diseases (CAD, heart failure, COPD), outcomes are particularly poor. In one study of ICU patients with chronic conditions, only 5% survived to discharge, and 4 of 6 survivors died within one year. 4 This underscores the importance of considering underlying disease burden when making resuscitation decisions. 4