Ebell MH, Smith M, Kruse JA, Drader Wilcox J, Novak J.
Effect of race on survival following in-hospital cardiopulmonary resuscitation.
J Fam Pract 1995;40(6):571-7.

The purpose of this study was to determine whether patient race (black versus non-black) is an independent predictor of survival to discharge following in-hospital cardiopulmonary resuscitation (CPR). Patients who underwent in-hospital CPR during the period from April 1990 to June 1993 in one hospital and through June 1992 in two other hospitals were identified for inclusion in this study, in addition to all patients with a discharge diagnosis of cardiac arrest.

The sample consisted of 656 patients. Black patients were less likely to have an admitting diagnosis of myocardial infarction, less likely to have a history of coronary artery disease identified, and also had a higher serum creatinine clearance, a lower serum albumin level, a lower urine output for the first 24 hours, and a higher mean APACHE III score than nonblack patients.

The percentage of patients surviving the resuscitation effort long enough to be stabilized was not significantly different between blacks and nonblacks. However, black patients were less likely to survive to discharge following CPR than non-blacks (OR adjusted for hospital=0.31, 95% confidence interval=0.15 to 0.68). After controlling for hospital, sex, age, and clinical variables, race remained a significant predictor of survival to discharge.

The rate of survival to discharge was significantly lower for black than white patients after receiving CPR; however, there was no significant difference between racial groups in the rate of success of the resuscitative effort. Thus, the difference in survival to discharge is related to the medical care that was offered the patients after resuscitation. Possible explanations suggested by the authors include: difference in the intensity of care afforded to black patients, a greater likelihood for black patient to choose do-not-resuscitate order after the initial resuscitative effort, the presence of a greater severity of illness or chronic morbidity not measured by the APACHE III score, or the presence of other confounding variables not measure in this study.

The authors note that other potential confounders, such as SES, were not measured and may explain the race effects in this study. Evaluation of potential mediators, such as smoking, anxiety and depression, might also elucidate this association.