Cardiopulmonary resuscitation in hospitalized patients

Kyff, Jeffrey V.; Puri, Vinod K.; Raheja, Ramesh; Ireland, Terese

doi:10.1097/00003246-198701000-00009

Cited by 30 publications

(11 citation statements)

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“…Suljaga-Pechtel et al 16 (1984) 207 All adults Y x x x ? Bayer et al 17 (1985) 95 Adults Ն age 65 Y x x Dans et al 18 (1985) 88 All adults Y x x x x Kyff et al 20 (1987) For the studies meeting the minimal inclusion criteria, the overall rate of immediate survival was 43.1% (95% CI 42.5%, 43.6%) and the rate of survival to discharge was 14.6% (95% CI 14.3%, 15.0%). For the subset of studies meeting the strict criteria, the overall rate of immediate survival was 40.7% and the rate of survival to discharge was 13.4%.…”

Section: Discussionmentioning

confidence: 99%

Survival after in-hospital cardiopulmonary resuscitation

et al. 1998

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OBJECTIVE:To determine the rates of immediate survival and survival to discharge for adult patients undergoing in-hospital cardiopulmonary resuscitation, and to identify demographic and clinical variables associated with these outcomes. MEASUREMENTS AND MAIN RESULTS:The MEDLARS database of the National Library of Medicine was searched. In addition, the authors' extensive personal files and the bibliography of each identified study were searched for further studies. Two sets of inclusion criteria were used, minimal (any study of adults undergoing in-hospital cardiopulmonary resuscitation) and strict (included only patients from general ward and intensive care units, and adequately defined cardiopulmonary arrest and resuscitation). Each study was independently reviewed and abstracted in a nonblinded fashion by two reviewers. The data abstracted were compared, and any discrepancies were resolved by consensus discussion. For the subset of studies meeting the strict criteria, the overall rate of immediate survival was 40.7% and the rate of survival to discharge was 13.4%. The following variables were associated with failure to survive to discharge: sepsis on the day prior to resuscitation (odds ratio T he do-not-resuscitate (DNR) order has become well accepted and widely used in American hospitals, and for the majority of patients who die in the hospital, a DNR order has been written by the time of their death. 1-3 The decision to discuss or execute a DNR order is driven by several concerns: the patient's current quality of life, the likelihood that cardiopulmonary resuscitation (CPR) will be successful, the patient's long-term prognosis following successful resuscitation, and his or her anticipated quality of life following successful resuscitation. 4,5 Although judgments about quality of life are best assessed by the patient, physicians have typically been relied on to provide biomedical information and estimates of prognosis; this is consistent with a shared approach to medical decision making. Information about prognosis can either be communicated implicitly (e.g., "I don't think CPR is likely to help you") or explicitly ("Patients with your condition have a less than 1% chance of surviving to discharge after CPR"). The explicit approach has been shown in two studies to influence patient decisions about DNR orders, 6,7 so it is important that prognostic information be as accurate as possible.[Recent work has shown, however, that physicians are not accurate in predicting the outcome of CPR. In fact, when presented with detailed vignettes of actual patient cases, physician predictions of the likelihood of immediate survival following CPR were no better than random guessing, with an area under the receiver-operating characteristic (ROC) curve not significantly different from 0.5. 8 An analysis with the physician prediction of the likelihood of survival as the outcome variable in a multivariate regression shows that physicians appear to have an underlying cognitive model. However, this model overemphasizes the imp...

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Section: Discussionmentioning

confidence: 99%

Survival after in-hospital cardiopulmonary resuscitation

et al. 1998

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“…However, subjects overestimated their chances of surviving CPR, with a mean estimated 70% chance of immediately surviving CPR and a mean estimated 62% chance of surviving CPR to hospital discharge. Studies examining in‐hospital CPR have generally found a low percentage of survivors to discharge, ranging from 3.8% to 24% 14–17 . Less than 10% of the study sample accurately predicted CPR survival.…”

Section: Cpr Knowledge Preferences and Living Willsmentioning

confidence: 94%

Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population

Schonwetter¹,

Walker

Solomon

et al. 1996

J American Geriatrics Society

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“…Participants in the DNR decision have been studied in the acute hospital setting; 17% to 29% of the time there was no documentation of either patient or family participation in the development of DNR orders 9 . In one retrospective study of all nursing home deaths, 9% of DNR orders lacked documentation of consultation with patient or family in the DNR decision 2 …”

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confidence: 99%

Do‐Not‐Resuscitate Orders in an Extended‐Care Study Group

Meyers

Lurie

Breitenbucher

et al. 1990

J American Geriatrics Society

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We examined the charts of 911 nursing home patients in Hennepin County, Minnesota, to determine the prevalence of written do-not-resuscitate (DNR) orders. Information regarding demographic characteristics, and whether a surrogate decisionmaker was available and participated in the decision, was also collected. Twenty-seven percent of patients had DNR orders. Ninety percent of all patients had potentially available surrogate decisionmakers. However, for 31% of patients with DNR orders, there was no documentation of patient or surrogate participation in the DNR decision. Univariate analysis identified female sex; increased age, level of care (skilled versus intermediate), presence of a potential surrogate decisionmaker, and increasing length of time since nursing home admission as factors associated with presence of DNR orders. When a logistic regression model was used, increased age, increased length of time since nursing home admission, skilled versus intermediate level of care, and presence of a surrogate decisionmaker were independently associated with presence of DNR status. Several variables are independently associated with written DNR orders; their relationship to the factors physicians use in decision making requires further study.

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Cardiopulmonary resuscitation in hospitalized patients

Cited by 30 publications

References 0 publications

Survival after in-hospital cardiopulmonary resuscitation

Survival after in-hospital cardiopulmonary resuscitation

Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population

Do‐Not‐Resuscitate Orders in an Extended‐Care Study Group

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