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Multiple In-Hospital Resuscitation Efforts in the Elderly

Menon, Prema R. MD1; Ehlenbach, William J. MD, MSc2; Ford, Dee W. MD, MSCR3; Stapleton, Renee D. MD, PhD1

Critical Care Medicine:
doi: 10.1097/CCM.0b013e31829eb937
Clinical Investigations
Abstract

Objectives: The objective of this study was to determine the characteristics and survival rates of patients receiving cardiopulmonary resuscitation more than once during a single hospitalization.

Design: We analyzed inpatient Medicare data from 1992 to 2005 identifying beneficiaries 65 years old and older who underwent cardiopulmonary resuscitation more than once during the same hospitalization.

Measurements: We examined patient and hospital characteristics, survival to hospital discharge, factors associated with survival to discharge, median survival, and discharge disposition.

Results: We analyzed data from 421,394 patients who underwent cardiopulmonary resuscitation during the study period. Four lakh thirteen thousand four hundred three patients received cardiopulmonary resuscitation once during a hospitalization and survival was 17.7% with median survival after discharge being 20.6 months. There were 7,991 patients who received cardiopulmonary resuscitation more than once during the same hospitalization; 8.8% survived the efforts, and median survival after leaving the hospital was 10.5 months. Patients who received more than one episode of cardiopulmonary resuscitation during a hospitalization were significantly less likely to go home after discharge. Greater age, black race, higher burden of chronic illness, and receiving cardiopulmonary resuscitation in a larger or metropolitan hospital were associated with lower survival among patients receiving cardiopulmonary resuscitation more than once.

Conclusions: Undergoing multiple cardiopulmonary resuscitation events during a hospitalization is associated with substantially reduced short- and long-term survival compared with patients who undergo cardiopulmonary resuscitation once. This information may be useful to clinicians when discussing end-of-life care with patients and families of patients who have experienced return of spontaneous circulation following in-hospital cardiopulmonary resuscitation but remain at risk for recurrent cardiac arrest.

Author Information

1University of Vermont, Burlington, VT.

2University of Wisconsin School of Medicine and Public Health, Madison, WI.

3Medical University of South Carolina, Charleston, SC.

Drs. Ehlenbach and Menon had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Supported, in part, by an Association of Specialty Professors–CHEST Foundation of the American College of Chest Physicians Geriatric Development Research Award funded by Atlantic Philanthropies, the CHEST Foundation, the John A. Hartford Foundation, and the Association of Specialty Professors.

Dr. Menon received a training grant (T32 HL076122). Dr. Ehlenbach received Beeson Career Develop Award in Aging funded by The National Institute on Aging, The Atlantic Philanthropies, The John A. Hartford Foundation, the Starr Foundation, the National Institute on Neurological Disorders and Strokes, and an anonymous donor (1K23AG038352-01A1). He received grant support from the National Institutes of Health (National Institute on Aging). Dr. Stapleton received National Center for Research Resources Roadmap K12 award (8K12RR023265) and Centers of Biomedical Research Excellence award (5P20RR015557). He receives royalties from UpToDate and has received travel reimbursements from the American Thoracic Society. Dr. Ford has disclosed that she does not have any potential conflicts of interest.

Address requests for reprints to: Prema R. Menon, MD, 89 Beaumont Avenue, Given D 208, Burlington, VT 05405. E-mail: prema.menon@vtmednet.org

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins