Short- and long-term survival after cardiopulmonary resuscitation.

BACKGROUND: The objective was to evaluate the effect of patient characteristics and other factors on cardiopulmonary resuscitation (CPR) survival, hospital discharge survival and function, and long-term survival. METHODS: All patients 18 years and older experiencing in-hospital CPR from December 1983 through November 1991 at Marshfield Medical Center (Marshfield Clinic and adjoining St Joseph's Hospital), Marshfield, Wis, were selected. We performed a retrospective medical record review and augmented these data with updated vital status information. MAIN OUTCOME MEASURES: Cardiopulmonary resuscitation survival, hospital discharge survival and function, and long-term survival. RESULTS: Of 948 admissions during which CPR was performed, 61.2% of patients survived the arrest and 32.2% survived to hospital discharge. Mechanism of arrest was the most important variable associated with hospital discharge. Patients with pulseless electrical activity had the worst chance of hospital discharge, followed by those with asystole and bradycardia. Follow-up information was available for 298 patients who survived to discharge. One year after hospital discharge, 24.5% of patients, regardless of age, had died. Survival was 18.5% at 7 years in those 70 years or older, compared with 45.4% in those aged 18 to 69 years. Heart rhythm at the time of arrest strongly influenced long-term survival. Bradyarrhythmias produced a nearly 2-fold increased mortality risk compared with normal sinus rhythm. CONCLUSIONS: Survival until hospital discharge after CPR at our institution during an 8-year period was higher than previously reported for other institutions. Long-term survival after discharge was equal to or higher than reported estimates from other institutions. Hospital admission practices and selection of patients receiving CPR may account for these findings.

Football injuries in a rural area.

This study was conducted to analyze the frequency and characteristics of football injuries in a rural hospital setting and compare it to the national data. More than 6,000 patients with a sport-related injury presenting to the emergency medicine department at the Marshfield Clinic between June 1, 1988 and June 1, 1994 were collected prospectively. Eight hundred forty-three (14% of total) patients sustained football-related injuries. A chart abstraction form was then used to retrospectively review football injuries documenting types, sites, and mechanism of injury, along with demographic aspects. The peak age sustaining football injuries was 17 years old (17.5%). Most of the football injuries occurred during school activities (73.7%). The most common site injured was the finger (16.5%), followed by the knee (15.7%). Sprains/strains were the most common diagnosis representing 40.2% of injuries overall. The most common mechanism resulting in a football-related injury was as a result of being blocked or tackled (52.7%). Surgery was required on 4.9% of individuals injured while playing football. Most patients (69.7%) were expected to recover from their injury within 14 days. There were more injured football players from our area in the age group 15 to 24 years as compared to the national data available. Diagnosis, site injured, and mechanism of injury from our study were comparable to other national publications. Prospective studies are needed to address the problem of football-related injuries. Such studies would require a multidiscipline team of experts.