Age and Other Determinants of Survival After In-hospital Cardiopulmonary Resuscitation

O'Keeffe, Shaun T; Redahan, C; Keane, Padraig; Daly, Kathleen

doi:10.1093/qjmed/81.3.1005

Cited by 62 publications

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“…Despite the fact that our study did not show a significant relationship between survival rate and the types of cardiac rhythm at the initiation of CPR, many researchers have still reported that ventricular fibrillation (VF)/ventricular tachycardia (VT) as the initial rhythm may have a better outcome than other rhythms 6,8,9,14 . In particular, elderly patients had a poor survival following an unwitnessed arrest or if a non-ventricular arrhythmia was present on the initial electrocardiogram 2,6,9 .…”

Section: Discussioncontrasting

confidence: 69%

“…Survival rate are even lower in elderly people although this probability reflects the effects of co-morbid illness rather than age itself 4,8 , especially for those patients with cancer, pneumonia, sepsis, unplanned surgery, impaired functional capacity and medical ICU admission having little likelihood of surviving to discharge following a cardiac arrest 2,9,10,11,12 . Elderly patients can have multiple illnesses and some investigators have suggested that this could account for the poor survival reported in this group 9 . It has also been noted that long-term mortality is associated with renal function 10 .…”

Section: Discussionmentioning

confidence: 96%

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Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

Tsai

Lin

Peng

et al. 2012

International Journal of Gerontology

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s u m m a r yBackground: Cardiopulmonary resuscitation during hospitalization has a great impact on both economic and medical issues. We sought to investigate: (1) whether different nursing-care behavior would alter the in-hospital resuscitation success rate; and (2) whether the success rate was influenced further by different age groups. Materials and methods: From January to December 2007, a total of 983 cases underwent cardiopulmonary resuscitation (CPR) in a tertiary medical center. Of these, the 170 cases resuscitated on the general wards were included in our study, but the 543 events that occurred in the emergency department and the 270 events that occurred in the intensive care units were excluded. Cases were further divided into two groups based on age (O for age greater than or equal to 65 years; Y for age less than 65 years). The baseline hospitalization information and nursing factors in the prediction of immediate outcome after CPR in different age populations were tested by multivariate logistic regression. Results: Of the 983 cases, 170 had detailed records prior to CPR. There was a significant relationship in the success rate of initial resuscitation after CPR between the elderly and young population (p ¼ 0.047). After multivariate adjustments for: signed as "do not resuscitate"; the type of rhythm acquired during resuscitation; the duration of staff visit; and the duration of CPR, we found that a prolonged CPR process was associated with a higher mortality rate in both groups (adjusted OR: 0.241, p ¼ 0.001 in the O group vs. 0.220, p ¼ 0.001 in the Y group). A longer interval between medical staffs' visits before CPR was associated with higher mortality in the O group (adjusted OR: e0.048, p ¼ 0.015) as compared with the Y group. Conclusion: Although the initial resuscitation success rate was not affected by age, a longer time interval between the last medical staffs' visit and the onset of resuscitation did result in a worse success rate in elderly patients. Our data suggest that more frequent staff visits to the elderly population during hospitalization could alter initial resuscitation results.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 96%

Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

Tsai

Lin

Peng

et al. 2012

International Journal of Gerontology

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“…Compared with the CPR outcome of our nondialysis patients and those in other reports, we found our intra-HD CPR outcome to be frustrating [6][7][8]. It is known that pre-arrest morbidities, such as age, heart disease, unconsciousness, mechanical ventilation, sepsis and hypotension are important factors affecting the outcome of CPR in nondialysis patients [4,6,[9][10][11][12][13][14][15]. In our study, the patients with intra-HD CPR had a high mean age (66.8 B 16.8 years) and a high pre-arrest morbidity index (10.5 B 3.4).…”

Section: Discussionmentioning

confidence: 81%

Clinical Findings and Outcomes of Intra-Hemodialysis Cardiopulmonary Resuscitation

Lai¹,

Hung²,

Huang³

et al. 1999

Am J Nephrol

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Renal failure with severe uremia is still an important cause of mortality, despite effective renal replacement therapy. Cardiopulmonary arrest (CPA) is the most severe complication during hemodialysis (HD). To acquire more information about cardiopulmonary resuscitation (CPR) during HD, we retrospectively enrolled 24 patients (11 males and 13 females) who had CPR during HD in a medical center during a 3-year period. Their mean age was 66.8 ± 16.8 years. The CPR rate of the patients from our outpatient department (0.02%) was significantly lower than that from general wards (0.11%), the intensive care unit (ICU, 0.16%), or the emergency room (ER, 0.38%). Eighteen patients (75%) were initially resuscitated successfully. Only 11 patients (45.8%) survived more than 24 h after CPR, and 2 patients (8.3%) survived more than 1 month, but none survived until discharge. The rates of surviving 24 h and surviving to discharge during HD were lower than those in the general wards, the ICU or the ER. Sepsis (33.3%) and cardiogenic shock (25%) were the two leading causes of death. For analyzing factors affecting the outcome of CPR, we divided the patients into 2 groups by survival time (≦24 vs. >24 h). Patients with heart disease or with prolonged CPR durations (>30 min) had shorter survival. No significant survival difference between the 2 groups was found due to factors of age, sex, diabetic nephropathy, pre-arrest morbidity scores, pre-arrest laboratory data, renal failure pattern, HD duration, the preceding HD time and ultrafiltrated volume.

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“…These facilities are scare throughout the globe and the distributive justice comes into play. In this course, several parameters like terminal illness, multi-organ failure, co-morbidities and age [39] of the patient etc. are considered for triaging the patients and/or deciding the medical futility.…”

Section: Justicementioning

confidence: 99%

Ethical Analysis of Medical Futility in Cardiopulmonary Resuscitation

RK¹

2014

J Clinic Res Bioeth

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Cardiopulmonary Resuscitation (CPR) is a life-saving intervention in emergency medical care practiced globally for the last more than seven decades. It cannot be a solution to prevent every death and there are risks associated with this intervention. This article focuses on the ethical dilemmas related to the decisions of medical futility in cardiopulmonary resuscitation particularly in emergency settings. There are guidelines for the decisions to start and stop CPR but are mostly based on technical grounds only. Technically possible interventions are not always medically reasonable and all four principles of biomedical ethics -viz. respect for autonomy, beneficence, nonmaleficence and justice are associated with the issues of medical futility in this process. Autonomy deals with the issues of the individual right for CPR as well as the other side of the coin do-not-resuscitate (DNR) including death with dignity. The 'advance directive' and the need for surrogate consent are further dimensions of autonomy. As a life saving measure, beneficence comes into play while non-maleficence argues against performing CPR when the outcomes are harmful or futile. Futile interventions have to be avoided for the justice so that the precious intensive care units are not occupied waiting for the end-of-life. Literatures were reviewed and analyzed in the context of medical futility in CPR and the ethical dimensions of the issues have been explored. Ethical approach assists in deciding the futility of cardiopulmonary resuscitation in a given situation where the shared decision is taken by the medical professionals and the surrogates of the patients.

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Age and Other Determinants of Survival After In-hospital Cardiopulmonary Resuscitation

Cited by 62 publications

References 0 publications

Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

Prolonged Cardiopulmonary Resuscitation Process and Lower Frequency of Medical Staff Visit Predicts Independently In-hospital Resuscitation Success in the Elderly Population

Clinical Findings and Outcomes of Intra-Hemodialysis Cardiopulmonary Resuscitation

Ethical Analysis of Medical Futility in Cardiopulmonary Resuscitation

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