The odds of surviving long enough to leave the
hospital drop with increasing age, the researchers found. And those
who are discharged may be left with functional deficits.
“Most patients that I talk to are surprised about how few patients
actually survive to hospital discharge,” Dr. William Ehlenbach told
“I think that if you have a loved one, an older person who is in the
hospital, I think having a realistic understanding of CPR and
outcomes is really important,” said Ehlenbach, a specialist in
pulmonary and critical care at the University of Wisconsin, who was
not involved in the study.
Cardiopulmonary Resuscitation (CPR) is the standard treatment for
cardiac arrest worldwide, but physicians tend not to accurately
predict the outcome, even after reading detailed patient
information, the study’s authors write in the journal Age and Aging.
“With increasing age of in-hospital patients, physicians are
frequently confronted with the question if resuscitation is a
medically appropriate and ethically acceptable treatment for an
older patient,” they note.
The study was led by Dr. Dionne Frijns, a geriatric medicine
researcher at Diakonessenhuis hospital in Utrecht, the Netherlands.
For doctors and patients to make informed choices about
resuscitation in the hospital, better information about the
consequences is needed, they say.
The researchers systematically reviewed previous studies that
investigated the survival rates of patients undergoing in-hospital
CPR. They included a total of 29 studies that involved a total of
417,190 patients over the age of 70.
The researchers found that about 40 percent of the patients had
successful CPR, or ‘return of spontaneous circulation,’ but more
than half of those patients ultimately died in the hospital.
For patients aged 70 to 79, the rate of survival to discharge was
about 19 percent, for patients aged 80 to 89, the rate was 15
percent and less than 12 percent of patients over the age of 90 were
Only four of the studies looked at the quality of life of CPR
survivors who left the hospital. Two studies indicated that patients
maintained levels of independence similar to what they had before
CPR, but the other two found that just 20 to 40 percent of survivors
were able to function independently outside of the hospital.
“Even though the survival rates appear to be low in older people in
general . . . there could be certain elderly patients for whom CPR
is a worthwhile intervention,” the authors write. “Future research
should focus on pre-arrest factors" that could predict which
patients most likely to benefit from CPR, they conclude.
Ehlenbach thinks that understanding the probabilities of survival
after CPR have the potential to affect the decisions that people
make at a very difficult time.
[to top of second column]
He points out that patients who are successfully resuscitated may
spend extra days or weeks in the hospital, but still not survive.
“For those patients what we're really doing is prolonging their
death rather than restoring health or restoring life,” he said.
For those who survive with functional deficits, Ehlenbach added, “We
just don't have a good base of studies to help us estimate what that
likelihood of a new deficit or neurologic disability is. There
really haven’t been a tremendous number of studies that look at
But, Ehlenbach said, patients he talks to are very interested in
knowing if they’ll be able to function independently if they ever
“Certainly what I hear from patients in my practice as a critical
care physician, is that patients - particularly older patients - are
very much thinking about survival,” he said. “But not only thinking
about survival, they're really thinking very much about functional
status and so that's important.”
Ehlenbach recommends that everyone, especially older adults with
advanced chronic illness, talk to their loved ones about their
wishes regarding resuscitation, including advanced directive
documents, living wills and health care power of attorney.
“Many of those decisions are made during an acute illness or
catastrophic illness and many times the individual themselves isn't
making that decision,” he said. “They may be too sick at that moment
so often times it's loved ones - spouses and children - who are
actually having those conversations with physicians.”
Ehlenbach added that for the past two decades there’s been a lot of
emphasis on encouraging physicians and other providers to talk about
these issues with all patients when they are hospitalized, but that
those conversations still don’t take place as often as they should.
“I think patients need to feel empowered to bring up these
conversations, particularly when they are being admitted to the
hospital,” he said. “So if their physician isn't the one initiating
the conversation, the patients should really feel empowered to make
sure that their wishes are known - regardless of what those wishes
SOURCE: http://bit.ly/1fUyOhD Age and Ageing, online April 22, 2104.
[© 2014 Thomson Reuters. All rights
Copyright 2014 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.