Three Predictors of Success in Cardiac Arrest

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with good patient outcomes.

1. Is first pass success of orotracheal intubation important? [1]

  • What they did:
    • Is there an association of first pass intubation success with incidence of adverse events (AEs)?
    • Retrospective analysis
    • 1,828 orotracheal intubations
    • Single academic ED
  • Primary Outcomes:
    • AEs: aspiration, oxygen desaturation, dental trauma, laryngospasm, pneumothorax, esophageal intubation, hypotension, dysrhythmia, and cardiac arrest
  • Results:
    • Most common AE was oxygen desaturation
    • First attempt success = 14.2% AEs
    • Two attempts = 47.2% AEs
    • Three attempts = 63.6% AEs
    • Four or more attempts = 70.6% AEs
  • Limitations:
    • Single center study
    • Retrospective analysis
    • Data was self-reported which could cause recall bias and under reporting of AEs
  • Conclusion: As the number of attempts increases, the incidence of AEs increases substantially

2. Does the rate of CPR matter? [2]

  • What they did:
    • Prospective observational study
    • 3 hospitals
    • 97 cardiac arrests
    • Measured chest compression rates
  • Primary Outcome:
    • Return of spontaneous circulation (ROSC)
  • Results:
    • CPR rate
    • CPR rate
    • CPR rate of patients with ROSC 90 +/- 17
    • CPR rate of non-survivors 79 +/- 18

Chest Compression Rate and ROSC

  • Limitation:
    • Data collected from an observer (human error)
  • Conclusion: Suboptimal chest compression rates correlate with poor ROSC.

3. How important is the End-Tidal Carbon Dioxide in cardiac arrest? [3]

  • What they did:
    • Prospective, observational study
    • 737 cases of out-of-hospital cardiac arrest
    • Recorded the partial pressure of end-tidal carbon dioxide (PetCO2) measured during CPR
  • Primary Outcome:
    • PetCO2 predicting restoration of spontaneous circulation (ROSC)
  • Results:
    • Average PetCO2 = 6.9 +/- 2.2 mmHg in patients without ROSC
    • Average PetCO2 = 32.8 +/- 9.1 mmHg in patients with ROSC
    • PetCO2
  • Conclusions: PetCO2 > 14.3 mmHg after 20 minutes of ACLS predicts ROSC with accuracy


First pass intubation successhigh-quality chest compressions at rate of 100 bpm, and PetCO2 >14.3 mmHg during CPR are important predictors for success in the resuscitation of patients in cardiac arrest. [4]


  1. Sakles JC et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med 2013. PMID: 23574475
  2. Abella BS et al. Chest Compression Rates During Cardiopulmonary Resuscitation are Suboptimal: A Prospective Study During In-Hospital Cardiac Arrest. Circulation 2005. PMID: 15687130
  3. Kolar M et al. PArtial Pressure of End-Tidal Carbon Dioxide Successful Predicts Cardiopulmonary Resuscitation in the Field: A Prospective Observational Study. Critical Care 2008. PMID: 18786260
  4. Abella BS. The Importance of Cardiopulmonary Resuscitation Quality. Currently Open Crit Care 2013. PMID: 23587758
Cite this article as: Salim Rezaie, "Three Predictors of Success in Cardiac Arrest", REBEL EM blog, January 25, 2014. Available at:

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