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Cardiopulmonary resuscitation: What cost to cheat death?

Lee, Kang H. MB, BChir; Angus, Derek C. MB, ChB, MPH, FCCP; Abramson, Norman S. MD, FCCM

Special Article

Objectives To review the various outcomes from cardiopulmonary resuscitation (CPR), the factors that influence these outcomes, the costs associated with CPR, and the application of cost-analyses to CPR.

Data Sources Data used to prepare this article were drawn from published articles and work in progress.

Study Selection Articles were selected for their relevance to the subjects of CPR and cost-analysis by MEDLINE keyword search.

Data Extraction The authors extracted all applicable data from the English literature.

Data Synthesis Cost-analysis studies of CPR programs are limited by the high variation in resources consumed and attribution of cost to these resources. Furthermore, cost projections have not been adjusted to reflect patient-dependent variation in outcome. Variation in the patient's underlying condition, presenting cardiac rhythm, time to provision of definitive CPR, and effective perfusion all influence final outcome and, consequently, influence the cost-effectiveness of CPR programs.

Based on cost data from previous studies, preliminary estimates of the cost-effectiveness of CPR programs for all 6-month survivors of a large international multicenter collaborative trial are $406,605.00 per life saved (range $344,314.00 to $966,759.00), and $225,892.00 per quality-adjusted-life-year (range $191,286.00 to $537,088.00).

Conclusions Reported outcome from CPR has varied from reasonable rates of good recovery, including return to full employment to 100% mortality. Appropriate CPR is encouraged, but continued widespread application appears extremely expensive. (Crit Care Med 1996; 24:2046-2052)

From the Health Delivery and Systems Evaluation Team (HeDSET), Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh (Drs. Lee and Angus), Pittsburgh, PA; and the Department of Emergency Medicine, Ohio State University (Dr. Abramson), Cleveland, OH.

Literature search and cost analyses were conducted at the University of Pittsburgh School of Medicine, Pittsburgh, PA.

Supported, in part, by grant NS-15295 from the National Institutes of Health.

Address requests for reprints to: Dr. Derek C. Angus, Critical Care Medicine, Room 606B Scaife Hall, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213.

© Williams & Wilkins 1996. All Rights Reserved.