Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Survival rates for elderly receiving hospital CPR did not improve from 1992 to 2005

07.07.2009
Proportion of deaths after CPR rose, and rate of successful resuscitation and later discharge fell

A study of elderly patients receiving CPR in the hospital shows that rates of survival did not improve from 1992 to 2005. During that period, the proportion of hospital deaths preceded by CPR rose, and the proportion of patients who were successfully resuscitated and later discharged home fell. The researchers found that 18.3 percent of the Medicare beneficiaries age 65 and older who underwent in-hospital CPR survived to discharge.

Elderly black patients were more likely to receive CPR, but less likely to survive, partially because they were more likely to be treated in hospitals with lower rates of post-CPR survival and perhaps more likely to request that resuscitation be attempted, according to the report, which was published today in The New England Journal of Medicine. The adjusted odds for survival for black elderly patients were 23.6 percent lower than for similar white patients. Older age, being a man, having more co-existing chronic illnesses, and residing in a skilled nursing facility before hospitalization also lessened the chances of survival, according to this study's findings. Higher income did not improve survival.

The researchers looked at records of 433,985 patients who both received CPR in U.S. hospitals from 1992 to 2005 and had Medicare coverage through the Old-Age and Survivors Insurance Fund, but who were not recipients of Social Security Disability Income or enrolled in an HMO.

The first author of the study is Dr. William J. Ehlenbach, senior fellow, Division of Pulmonary and Critical Care Medicine at Harborview Medical Center and the University of Washington (UW) in Seattle, and the senior author is Dr. Renee D. Stapleton, formerly of the UW and now at the Division of Pulmonary Care, University of Vermont College of Medicine.

"CPR has become the default response to cardiac arrest in or out of the hospital," the researchers noted. The authors conducted the study because it was unclear whether advances in CPR or in care after cardiac arrest have improved outcomes.

"Of significant concern," they wrote, "is our finding that the proportion of patients who died in the hospital after previously having undergone in-hospital CPR has increased during a time of more education and awareness of the limits of CPR in patients with advanced chronic illness and life-threatening acute illness."

They added that although Do Not Attempt Resuscitation orders became more common during the 1980s, their availability has not effectively decreased the frequency of administering CPR to patients who are unlikely to benefit.

One possibility for their findings, the researcher noted, is that attempts to enhance the delivery of CPR have been less successful than changes in out-of-hospital resuscitation efforts, such as bystander CPR and automatic defibrillators, trained emergency response units, and dispatchers providing CPR instruction over the phone, that have contributed to improved survival. The findings might also reflect changes over the years in the type and severity of illness, the underlying causes of the cardiac arrest, or the initial heart rhythm abnormality that made the heart stop beating. For example, people whose cardiac arrest occurs from ventricular fibrillation or fluttering or from an abnormally rapid heart rate are more likely to survive than someone whose heart shows pulseless electrical activity. In addition, heart disease has declined in the United States, but critical illnesses such as severe sepsis leading to irreversible shock have increased.

The researchers also found that patients who were successfully resuscitated and later discharged were more likely to be sent to a health-care facility than to return home. They added that this finding might reflect the trend toward shorter hospital stays or it could be due to neurological or functional damage from the cardiac arrest.

A limitation of the study, according to the researchers, is that the Medicare claims data do not contain potential predictors of survival after CPR, such as severity and type of underlying illness, the type of heart rhythm problem preceding cardiac arrest, patient location in hospital, and time to defibrillations. Knowing such factors, they explained, may also help in understanding differences in survival associated with race and hospital.

The researchers hope the study provides information useful to older patients and their doctors when deciding whether to choose to attempt resuscitation. They also hope their findings stimulate efforts to understand the association between race and survival to eliminate disparities, and to learn more about the specific factors associated with the incidence of CPR and the rate of survival for patients of all races.

In addition to Ehlenbach and Stapleton, the study authors are Dr. Amber E. Barnato, Department of Medicine, University of Pittsburgh; Dr. J. Randall Curtis, Division of Pulmonary and Critical Care, Harborview and UW School of Medicine; Dr. William Kreuter, UW Comparative Effectiveness Costs and Outcomes Research Center; Dr. Thomas D. Koepsell, Department of Epidemiology, UW School Public Health; and Dr. Richard A. Deyo, Department of Family Medicine and Medicine, Oregon Health Sciences University.

The research was funded by a Physicians Geriatric Development Research Award from the American College of Physicians CHEST Foundation, Atlantic Philanthropies, the John A. Hartford Foundation and the Association of Specialty Professors; a National Center for Research Roadmap Award and additional awards from the National Institutes of Health; and a Centers of Biomedical Research Excellence Award.

Leila Gray | EurekAlert!
Further information:
http://www.washington.edu

More articles from Studies and Analyses:

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

nachricht Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Fizzy soda water could be key to clean manufacture of flat wonder material: Graphene

Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.

As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...

Im Focus: Exotic quantum states made from light: Physicists create optical “wells” for a super-photon

Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.

Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...

Im Focus: Circular RNA linked to brain function

For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.

While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...

Im Focus: RAVAN CubeSat measures Earth's outgoing energy

An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.

The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...

Im Focus: Scientists shine new light on the “other high temperature superconductor”

A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.

Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Call for Papers – ICNFT 2018, 5th International Conference on New Forming Technology

16.08.2017 | Event News

Sustainability is the business model of tomorrow

04.08.2017 | Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

 
Latest News

A Map of the Cell’s Power Station

18.08.2017 | Life Sciences

Engineering team images tiny quasicrystals as they form

18.08.2017 | Physics and Astronomy

Researchers printed graphene-like materials with inkjet

18.08.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>