Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis

Ebell, Mark H.; Afonso, Anna M.

doi:10.1093/fampra/cmr023

Cited by 135 publications

(156 citation statements)

References 52 publications

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“…Several investigations have reported low hospital discharge survival aft er CPR in patients with malignancy. [26][27][28] A 2006 meta-analysis of 1,707 patients with cancer found that 6.2% of all CPR recipients with malignancy and 5.6% of those with metastases survived to hospital discharge, 26 whereas we found that 12.3% of all patients with malignancy and 11.7% of patients with severe malignancy survived to hospital discharge. A possible explanation for these confl icting results is differing study populations.…”

Section: Discussioncontrasting

confidence: 52%

Long-term Outcomes After In-Hospital CPR in Older Adults With Chronic Illness

Stapleton

Ehlenbach

Deyo

et al. 2014

Chest

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Section: Discussioncontrasting

confidence: 52%

Long-term Outcomes After In-Hospital CPR in Older Adults With Chronic Illness

Stapleton

Ehlenbach

Deyo

et al. 2014

Chest

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“…2,4,7,10,11 Furthermore, patients who were successfully resuscitated often undergo aggressive treatment in the intensive care unit and suffer complications including rib fractures, permanent neurological deficits, and impaired functional status. 4,12,13 Even without physical injury, CPR can lead to psychological harm that lowers survivors' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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“…A primary diagnosis of acute myocardial infarction has been associated with increased survival rate to discharge [19], whereas the presence of cancer, metastatic disease, sepsis or pneumonia has been associated with poor outcome. Our patients were reported to have suffered from cardiac arrest in the majority of the cases, a higher proportion than that reported in the literature [25], yet only 30% suffered from acute myocardial infarction indicating that the labeling of cardiac arrest is probably overestimated or that it was a mixed respiratory cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

“…In addition use of mechanical ventilation, vasopressors in critically ill patients are indicators of low likelihood of survival following arrests [13] [17] [18]. On the other hand, acute myocardial infarction and the presence of shockable rhythms such as ventricular tachycardia (VT) or ventricular fibrillation (VF) have been associated with good outcome [19], four to five times higher than patient with asystole or pulseless electrical activity (PEA).…”

mentioning

confidence: 99%

Older Adults Had Similar Survival Rates Compared to Their Younger Counterparts Following Cardiopulmonary Resuscitation

Ahmar¹,

Eid²,

Imad³

et al. 2017

AAR

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Background: Several factors affect the outcome of cardiopulmonary resuscitation (CPR) following in hospital cardiac arrests, including presence of comorbidities, arrest characteristics, and resuscitation efforts. We sought to determine the outcome of CPR provided to elders suffering from in-hospital cardiopulmonary arrest and to compare it to the survival of their younger counterparts in a tertiary care center in Lebanon. Methods: Retrospective chart review of all patients suffering from cardiac arrests who received CPR during a one year period in a tertiary care center located in a rural area. Results: A total of 98 cardiac arrests were identified who received CPR according to advance cardiac life support protocols (ACLS). Initial return of spontaneous circulation was higher among younger subjects but the difference was not statistically significant (52.6% vs 34.2%, p = 0.136). Survival to discharge was low but slightly higher in the younger subgroup, yet the difference was not statistically significant (5% vs 3%, p = 0.535). Conclusions: Physicians need to be aware of the outcome of CPR in the hospitals they practice in. They can educate their patients about CPR outcome. Such education may help patients and their next of kin make informed decisions jointly with their physician regarding resuscitation.

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Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis

Abstract: We identified several pre-arrest variables associated with failure to survive to discharge. This information should be shared with patients as part of a shared decision-making process regarding the use of do not resuscitate orders.

Cited by 135 publications

References 52 publications

Long-term Outcomes After In-Hospital CPR in Older Adults With Chronic Illness

Long-term Outcomes After In-Hospital CPR in Older Adults With Chronic Illness

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

Older Adults Had Similar Survival Rates Compared to Their Younger Counterparts Following Cardiopulmonary Resuscitation

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