Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

Ehlenbach, William J.; Barnato, Amber E.; Curtis, J. Randall; Kreuter, William; Deyo, Richard A.; Stapleton, Renee D.

doi:10.1056/nejmoa0810245

Cited by 308 publications

(258 citation statements)

References 39 publications

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“…The unadjusted survival rate of 17.0% in our study was lower than the 18.3% survival found in a recent study of Medicare patients 10 largely because we excluded cardiac arrests in the emergency room and procedural areas -which are known to have higher survival. 23,24 Although the Medicare study did not detect survival trends, 10 several factors likely explain our different findings. Since that study used procedure codes for CPR to identify cardiac arrest patients, it is possible that some patients who received CPR for bradycardia (and not cardiac arrest) were included.…”

Section: Discussionmentioning

confidence: 73%

Trends in Survival after In-Hospital Cardiac Arrest

2013

N Engl J Med

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Section: Discussionmentioning

confidence: 73%

Trends in Survival after In-Hospital Cardiac Arrest

2013

N Engl J Med

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“…1,2 Concerns that poor performance of CPR impairs haemodynamic status and affects survival rates led to an extensive evaluation of adult basic and advanced life support guidelines by the International Liaison Committee on Resuscitation at the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science in 2005. 3 The Australian Resuscitation Council (ARC) followed this with the release of the ARC Previous guidelines resulted in too much 'hands-off time' and contributed to poor-quality CPR, 3 with suboptimal chest compression and ventilation rates 5 correlated with poor pos-resuscitation survival rates.…”

Section: Introductionmentioning

confidence: 99%

In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines

Boyde¹,

Padget²,

Burmeister³

et al. 2013

Aust. Health Review

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link What is known about this topic?The evaluation of outcomes from in-hospital cardiac arrests focuses on immediate survival expressed as ROSC and survival to hospital discharge. These clinical outcomes have not improved substantially over the last two decades. What does this paper add?This paper identifies the factors that are related to ROSC and survival to discharge following the implementation of the ARC 2006 guidelines which included a refocus on providing quality CPR with minimal interruptions. What are the implications for practitioners?Given that multiple factors can influence clinical outcomes following an in-hospital cardiac arrest, focusing on maximising a range of factors surrounding CPR is essential to improve outcomes.

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“…[2][3][4] This rate has not measurably improved over the last 20 years. [5][6][7][8][9] For patients with certain diagnoses (e.g., metastatic cancers), survival rates are even lower. 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.…”

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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Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

Abstract: BACKGROUND-It is unknown whether survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which patient and hospital characteristics predict survival.

Cited by 308 publications

References 39 publications

Trends in Survival after In-Hospital Cardiac Arrest

Trends in Survival after In-Hospital Cardiac Arrest

In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines

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

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