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Cardiopulmonary resuscitation in older people – a review

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  27 January 2010

R Lannon  and
ST O'Keeffe
R Lannon
Affiliation:
Department of Geriatric Medicine, Galway University Hospitals, Ireland
ST O'Keeffe*
Affiliation:
Department of Geriatric Medicine, Galway University Hospitals, Ireland
*
Address for correspondence: Dr S O'Keeffe, Unit 4, Merlin Park Regional Hospital, Galway, Ireland. Email: [email protected] and [email protected]
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Summary

Survival to discharge after in-hospital cardiopulmonary resuscitation (CPR) is about 20% in those aged 65–69 years, declining with advancing age to about 10% in those aged 90 years or more. There are conflicting reports on whether or not advanced age, independent of the severity of acute and chronic illness, is a determinant of outcome. Recognition that the outcome of CPR in hospital patients is often poor has prompted extensive debate regarding the appropriate use of this procedure. In particular, there has been concern about unnecessary CPR in extended-care and hospice settings. Conversely, there has also been evidence that doctors and families may be prone to underestimate the quality of life and likelihood of benefit from CPR in older people and to make resuscitation decisions without considering the preferences of older people themselves. Recent guidelines have attempted to strike a balance between ensuring patient participation whenever possible but without offering illusory choices where CPR is very unlikely to succeed.

Keywords

Cardiopulmonary resuscitationaged
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 1 , February 2010 , pp. 20 - 29
Copyright
Copyright © Cambridge University Press 2010

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References

1Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed-chest cardiac massage. JAMA 1960; 173: 94–97.CrossRefGoogle ScholarPubMed
2Jude, JR, Kouwenhoven, WB, Knickerbocker, GG. Cardiac arrest: Report of application of external cardiac massage on 118 patients. JAMA 1961; 178: 1063–70.CrossRefGoogle ScholarPubMed
3Bedell, SE, Delbanco, TL, Cook, EF, Epstein, FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med 1983; 309: 569–76.CrossRefGoogle ScholarPubMed
4Eisenberg, MS, Bergner, L, Hallstrom, A. Out-of-hospital cardiac arrest: improved survival with paramedic services. Lancet 1980; 1: 812–15.CrossRefGoogle ScholarPubMed
5Ebell, MH, Becker, LA, Barry, HC, Hagen, M. Survival after in-hospital cardiopulmonary resuscitation: a meta-analysis. J Gen Intern Med 1998; 13: 805–16.CrossRefGoogle ScholarPubMed
6Ebrahim, S. Do not resuscitate decisions: flogging dead horses or a dignified death? BMJ 2000; 320: 1155–56.CrossRefGoogle ScholarPubMed
7Schneider, AP, Nelson, DJ, Brown, DD. In-hospital cardiopulmonary resuscitation: a 30-year review. J Am Board Family Practice 1993; 6: 91–101.Google ScholarPubMed
8Taffet, GE, Teasdale, TA, Luchi, RJ. In-hospital cardiopulmonary resuscitation. JAMA 1988; 260: 2069–72.CrossRefGoogle ScholarPubMed
9Warner, SC, Sharma, TK. Outcome of cardiopulmonary resuscitation and predictors of resuscitation status in an urban community teaching hospital. Resuscitation 1994; 27: 13–21.CrossRefGoogle Scholar
10Peberdy, MA, Kaye, W, Ornato, JP et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003; 58: 297–308.CrossRefGoogle Scholar
11Ehlenbach, WJ, Barnato, AE, Curtis, JR et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009; 361: 22–31.CrossRefGoogle ScholarPubMed
12Di Bari, M, Chiarlone, M, Fumagalli, S et al. Cardiopulmonary resuscitation of older, in-hospital patients: immediate efficacy and long term outcomes. Crit Care Med 2000; 28: 2320–25.Google Scholar
13Tresch, D, Heudebert, G, Kutty, K et al. Cardiopulmonary resuscitation in elderly patients hospitalized in the 1990s: a favourable outcome. J Am Geriatr Soc 1994; 42: 137–41.CrossRefGoogle Scholar
14Tunstall-Pedoe, H, Bailey, L, Chamberlain, DA, Marsden, AK, Ward, ME, Zideman, DA. Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. Br Med J 1992; 304: 1347–51.CrossRefGoogle ScholarPubMed
15Peberdy, MA, Ornato, JP, Larkin, GL et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008; 299: 785–92.CrossRefGoogle ScholarPubMed
16Jones-Crawford, JL, Parish, DC, Smith, BE, Dane, FC. Resuscitation in the hospital: circadian variation of cardiopulmonary arrest. Am J Med 2007; 120: 158–64.CrossRefGoogle ScholarPubMed
17Finucane, TE, Boyer, JT, Bulmash, J et al. The incidence of attempted CPR in nursing homes. J Am Geriatr Soc 1991; 39: 624–6.CrossRefGoogle ScholarPubMed
18Kane, RS, Burns, EA. Cardiopulmonary resuscitation policies in long-term care facilities. J Am Geriatr Soc 1997; 45: 154–57.CrossRefGoogle ScholarPubMed
19Hollenberg, J, Herlitz, J, Lindqvist, J et al. Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew-witnessed cases and bystander cardiopulmonary resuscitation. Circulation 2008; 118: 389–96.CrossRefGoogle ScholarPubMed
20Bonnin, MJ, Pepe, PE, Clark, PS Jr. Survival in the elderly after out-of-hospital cardiac arrest. Crit Care Med 1993; 21: 1619–21.CrossRefGoogle ScholarPubMed
21Herlitz, J, Engdahl, J, Svensson, L et al. Can we define patients with no chance of survival after out-of-hospital cardiac arrest? Heart 2004; 90: 1107–9.CrossRefGoogle ScholarPubMed
22de Vos, R, de Haes, HC, Koster, RW, de Haan, RJ. Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 1999; 159: 249–54.CrossRefGoogle ScholarPubMed
23Young, GB. Neurologic prognosis after cardiac arrest. N Engl J Med 2009; 361: 605–11.CrossRefGoogle ScholarPubMed
24Rogove, HJ, Safar, P, Sutton-Tyrrell, K et al. Old age does not negate good cerebral outcome after cardiopulmonary resuscitation: Analyses from the brain resuscitation clinical trials. Crit Care Med 1995; 23: 18–25.CrossRefGoogle Scholar
25Grubb, NR, O'Carroll, R, Cobbe, SM, Sirel, J, Fox, KA. Chronic memory impairment after cardiac arrest outside hospital. BMJ 1996; 313: 143–46.CrossRefGoogle ScholarPubMed
26Hadorn, DG. DNAR: do not attempt resuscitation. N Engl J Med 1989; 320: 673.Google Scholar
27Edgren, E. The ethics of resuscitation; differences between Europe and the USA – Europe should not adopt American guidelines without debate. Resuscitation 1992; 23: 85–90.CrossRefGoogle Scholar
28Bedell, SE, Pelle, D, Maher, PL, Cleary, PD. Do-not-resuscitate orders for critically patients in the hospital. JAMA 1986; 256: 233–37.CrossRefGoogle ScholarPubMed
29Bayliss, RIS. Thou shalt not strive officiously. Br Med J 1982; 285: 1373–75.CrossRefGoogle Scholar
30The Health Service Commission. Communications surrounding a decision not to resuscitate a patient. London: W.258/89–90, HMSO, 1991.Google Scholar
31Calman, K. Health Service Commissioner. Annual report for 1990–1991. Resuscitation policy. PL/CMO (91)22.26 December 1992.Google Scholar
32A statement from the British Medical Association and the Royal College of Nursing in association with the Resuscitation Council (UK). Decisions Relating to Cardiopulmonary Resuscitation. London, BMA, 1993.Google Scholar
33Mendick, R, Dillon, J. Fifty elderly on NHS death dossier. Independent on Sunday. 2000 April. 16:1. http://www.independent.co.uk/life-style/health-and-families/health-news/fifty-elderly-on-nhs-dossier-of-death-721094.html (accessed 12 Nov 2009).Google Scholar
34Soper, RH. A memorable patient. An unmerciful end. BMJ 2001; 323: 217.Google Scholar
35A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. Decisions Relating to Cardiopulmonary Resuscitation. http://www.bma.org.uk/images/DecisionsRelatingResusReport_tcm41–147300.pdf (accessed 12 Nov 2009).Google Scholar
36Beauchamp, TL, Childress, TF. Principles of Biomedical Ethics, 6th edn.New York: Oxford University Press, 2008.Google Scholar
37Schneider, CE. The Practice of Autonomy: Patients, Doctors, and Medical Decisions. New York: Oxford University Press, 1998.CrossRefGoogle Scholar
38Cowley, C. The dangers of medical ethics. J Med Ethics 2005; 31: 739–42.CrossRefGoogle ScholarPubMed
39Harris, J. In praise of unprincipled ethics. J Med Ethics 2003; 29: 303–6.Google ScholarPubMed
40Frank, C, Heyland, DK, Chen, B et al. Determining resuscitation preferences of elderly inpatients: a review of the literature. CMAJ 2003; 169: 795–99.Google ScholarPubMed
41Diem, SJ, Lantos, JD, Tulsky, J. Cardiopulmonary resuscitation on television: miracles and misinformation. N Engl J Med 1996; 334: 1578–82.CrossRefGoogle ScholarPubMed
42Fried, TR, O'Leary, J, Van Ness, P et al. Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment. J Am Geriatr Soc 2007; 55: 1007–14.CrossRefGoogle ScholarPubMed
43Murphy, DJ, Burrows, D, Santilli, S et al. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Engl J Med 1994; 330: 545–49.CrossRefGoogle ScholarPubMed
44Fidler, H, Thompson, C, Freeman, A et al. Barriers to implementing a policy not to attempt resuscitation on acute medical admissions: prospective cross sectional study of a successive cohort. BMJ doi:10.1136/bmj.38740.855914.BE (accessed 12 Nov 2009).CrossRefGoogle Scholar
45O'Keeffe, ST. Development and implementation of resuscitation guidelines: a personal experience. Age Ageing 2001; 30: 19–25.CrossRefGoogle ScholarPubMed
46Sayers, GM, Schofield, I, Aziz, M. An analysis of CPR decision-making by elderly patients. J Med Ethics 1997; 23: 207–12.Google ScholarPubMed
47Finucane, TE, Harper, GM. Attempting resuscitation in nursing homes: policy considerations. J Am Geriatr Soc 1999; 47: 1261–64.CrossRefGoogle ScholarPubMed
48Trugg, RD, Brett, AS, Frader, J. The problem with futility. N Engl J Med 1992; 326: 1560–64.CrossRefGoogle Scholar
49Curtis, JR, Park, DR, Krone, MR, Pearlman, RA. Use of the medical futility rationale in do-not-attempt-resuscitation orders. JAMA 1995; 273: 124–28.CrossRefGoogle ScholarPubMed
50Sokol, DK. The slipperiness of futility. BMJ 2009; 338: b2222.CrossRefGoogle ScholarPubMed
51Ouslander, JG, Tymchuk, AJ, Rahbar, B. Health care decisions among elderly long-term care residents and their potential proxies. Arch Intern Med 1989; 149: 1367–72.CrossRefGoogle ScholarPubMed
52Uhlmann, RF, Pearlman, RA. Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med 1991; 151: 495–97.CrossRefGoogle ScholarPubMed
53Sprangers, MA, Aaronson, NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol 1992; 45: 743–60.CrossRefGoogle ScholarPubMed
54George, ALJ, Folk, BP, Crecelius, PL, Campbell, WB et al. Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest. Am J Med 1989; 37: 28–34.CrossRefGoogle Scholar
55O'Keeffe, S, Ebell, MH. Prediction of failure to survive following in-hospital cardiopulmonary resuscitation: comparison of two predictive instruments. Resuscitation 1994; 28: 21–25.Google ScholarPubMed
56Bowker, L, Stewart, K. Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores. Resuscitation 1999; 40: 89–95.CrossRefGoogle ScholarPubMed
57Reisfield, GM, Wallace, SK, Munsell, MF et al. Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis. Resuscitation 2006; 71: 152–160.CrossRefGoogle ScholarPubMed
58Conroy, SP, Luxton, T, Dingwall, R, Harwood, RH, Gladman, JR. Cardiopulmonary resuscitation in continuing care settings: time for a rethink? BMJ 2006; 332: 479–82. doi:10.1136/bmj.332.198 7539.479 (accessed 12 Nov 2009).CrossRefGoogle ScholarPubMed
59O'Brien, M, O'Keeffe, ST. Resuscitation decisions in Irish long stay units. Ir J Med Sci 2009; www.springerlink.com/index/91u6277l80128418.pdf (accessed 12 Nov 2009).Google Scholar
60Woollard, M.Public access defibrillation: a shocking idea? J Public Health Med 2001; 23: 98–102. doi:10.1093/pubmed/23.2.98 (accessed 12 Nov 2009).CrossRefGoogle ScholarPubMed
61Vick, S, Scott, A. Agency in health care. Examining patient's preferences for attributes of the doctor-patient relationship. J Health Econ 1998; 17: 587–605.CrossRefGoogle ScholarPubMed
62Ende, J, Kazis, K, Ash, A et al. Measuring patient's desire for autonomy: decision making and information seeking preferences among medical patients. J Gen Intern Med 1989; 4: 23–30.CrossRefGoogle ScholarPubMed
63Wilkinson, C, Khanji, M, Cotter, PE, Dunne, O, O'Keeffe, ST. Preferences of acutely ill patients for participation in medical decision-making. Qual Saf Health Care 2008; 17: 97–100.CrossRefGoogle ScholarPubMed
64Puchalski, CM, Zhong, Z, Jacobs, MM et al. Patients who want their family and physician to make resuscitation decisions for them: observations from SUPPORT and HELP. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 2000; 48 (suppl): S84–90.CrossRefGoogle ScholarPubMed
65Ingelfinger, FJ. Arrogance. N Engl J Med 1980; 303: 507–11.CrossRefGoogle ScholarPubMed