Background: Patients with cirrhosis who suffer cardiac arrest often undergo cardiopulmonary resuscitation (CPR). However, there is limited data on the effectiveness of CPR in achieving survival or liver transplantation in this population. This study aimed to describe rates of survival after CPR, liver transplantation, and palliative care utilization for hospitalized patients with cirrhosis. Methods: Hospitalized patients with International Classification of Diseases 10th revision codes for cardiac arrest and cirrhosis from October 2017 to December 2022 were included. Patients were excluded if CPR was not performed or if diagnoses were incorrectly coded. Primary outcome was post-CPR survival. Secondary outcomes included rates of transplantation and specialty palliative care utilization. Cox regression models and the log-rank test were used to compare survival in those with and without decompensated cirrhosis. Results: A total of 126 patients were included; 88 had decompensated cirrhosis and 38 had compensated cirrhosis. Overall median survival was < 1 day. Thirty-day survival for compensated and decompensated cirrhosis was 39% and 7.9%, respectively ( p < 0.001). Decompensation was associated with a 2.5-fold increased risk of death within 30 days (95% CI: 1.6–3.0). Two patients reached transplant evaluation and were activated on the transplant wait-list. Specialty palliative care consultation occurred in 25 patients, with most occurring after the CPR event. Discussion: This study demonstrates that post-CPR trajectory differs with presence or absence of hepatic decompensation. Ability to reach liver transplant evaluation after CPR in patients with decompensated cirrhosis is significantly limited by poor survival. Further study is needed to inform goals of care discussions and implementation of primary and specialty palliative care in this population.
Tombazzi et al. (Thu,) studied this question.