Outcomes of Skilled Cardiopulmonary Resuscitation in a Long‐Term‐Care Facility: Futile Therapy?

Awoke, Sissay; Mouton, Charles P.; Parrott, Marian

doi:10.1111/j.1532-5415.1992.tb02109.x

Cited by 72 publications

(48 citation statements)

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“…Furthermore, the factors of nursing home residency [19,20,30,32,38] and pre-arrest comorbidity [27] were associated with decreased chances of survival. It was striking that only one study investigated the predictive value of pre-arrest comorbidity [27].…”

Section: Discussionmentioning

confidence: 99%

“…However, this study did not adjust for arrest factors and only examined witnessed arrests. Of the 23 included studies, six studies investigated the predictive value of nursing home residency for decreased survival to discharge [17,19,20,30,32,38] (Table 3). For this group, the absolute survival chances were low and ranged from 0–5.1%.…”

Section: Findings Of the Included Studiesmentioning

confidence: 99%

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Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

et al. 2013

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BackgroundTo enable older people to make decisions about the appropriateness of cardiopulmonary resuscitation (CPR), information is needed about the predictive value of pre-arrest factors such as comorbidity, functional and cognitive status on survival and quality of life of survivors. We systematically reviewed the literature to identify pre-arrest predictors for survival, quality of life and functional outcomes after out-of-hospital (OHC) CPR in the elderly.MethodsWe searched MEDLINE (through May 2011) and included studies that described adults aged 70 years and over needing CPR after OHC cardiac arrest. Prognostic factors associated with survival to discharge and quality of life of survivors were extracted. Two authors independently appraised the quality of each of the included studies. When possible a meta-analysis of odd’s ratios was performed.ResultsTwenty-three studies were included (n = 44,582). There was substantial clinical and statistical heterogeneity and reporting was often inadequate. The pooled survival to discharge in patients >70 years was 4.1% (95% CI 3.0-5.6%). Several studies showed that increasing age was significantly associated with worse survival, but the predictive value of comorbidity was investigated in only one study. In another study, nursing home residency was independently associated with decreased chances of survival. Only a few small studies showed that age is negatively associated with a good quality of life of survivors. We were unable to perform a meta-analysis of possible predictors due to a wide variety in reporting and statistical methods.ConclusionsAlthough older patients have a lower chance of survival after CPR in univariate analysis (i.e. 4.1%), older age alone does not seem to be a good criterion for denying patients CPR. Evidence for the predictive value of comorbidities and for the predictive value of age on quality of life of survivors is scarce. Future studies should use uniform methods for reporting data and pre-arrest factors to increase the available evidence about pre arrest factors on the chance of survival. Furthermore, patient-specific outcomes such as quality of life and post-arrest cognitive function should be investigated too.

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Section: Discussionmentioning

confidence: 99%

Section: Findings Of the Included Studiesmentioning

confidence: 99%

Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

et al. 2013

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“…Both of these indicators suggest reasonably severe levels of impairment in physical functioning and these may be relatively more important for subjective evaluations of quality of life than impairments in mobility, for example. Moreover, patients with relatively severe chronic disease rarely survive to hospital discharge after CPR and this intervention may therefore be viewed as relatively futile (Awoke, Mouton, & Parrott, 1992;Fisher, 1989;Murphy, 1988). However, it should also be recognized that, to some extent the problems associated with conditions such as incontinence may be modifiable.…”

Section: Discussionmentioning

confidence: 95%

The Specification of Levels of Active Intervention in a Chronic Care Hospital

Hirdes

Martin

1993

J Appl Gerontol

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Although decisions regarding the level of active intervention specified for a chronic care patient would ideally be made by autonomous individuals, these decisions may be influenced by a number of physical, psychological, and social factors. Some aspects of one's life experience would usually be considered reasonable criteria to form the basis for these decisions (e.g., severity of physical impairment), but the influence of other factors (e.g., social isolation) may be less appropriate. This study examines the characteristics associated with the specification of comfort measures only on the charts of patients in a Canadian chronic care hospital. Based on the results of multiple logistic regression models, patients with comfort measures only specified were significantly more likely to be older, recently admitted, incontinent, requiring special nutritional regimens, and were less likely to have been visited recently by key contact persons. The results raise the ethical question of what dimensions of quality of life should be considered as relevant determinants of advance treatment plans for the elderly.

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“…4 Cardiopulmonary resuscitation is largely irrelevant in the nursing home (it is effective less than 1% of the time when trained personnel are available and the vast majority of nursing homes are not equipped to provide advanced life support). 5 Moreover, DNR continues to be widely misunderstood and is misconstrued to indicate much more than "do not attempt cardiopulmonary resuscitation (CPR)." A recent study confirmed earlier findings that DNR is often interpreted to imply limitations on treatments, such as intensive care, surgery, dialysis, transfusions, and endoscopy.…”

Section: The Current Status Of Advance Medical Planning In Nursing Homesmentioning

confidence: 99%

Adapting Advance Medical Planning for the Nursing Home

Gillick

2004

Journal of Palliative Medicine

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Outcomes of Skilled Cardiopulmonary Resuscitation in a Long‐Term‐Care Facility: Futile Therapy?

Abstract: We conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long-term-care populations.

Cited by 72 publications

References 9 publications

Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

The Specification of Levels of Active Intervention in a Chronic Care Hospital

Adapting Advance Medical Planning for the Nursing Home

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