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Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults.
JAMA 1999 Dec 22-29; 282(24):2333-9JAMA

Abstract

CONTEXT

The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR).

OBJECTIVE

To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest.

DESIGN

Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting Five teaching hospitals across the United States.

PARTICIPANTS

A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest.

MAIN OUTCOME MEASURES

Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians.

RESULTS

Five hundred fourteen study subjects (21 %) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1 %) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60; 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure.

CONCLUSIONS

Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.

Authors+Show Affiliations

Division of Geriatrics, LDS Hospital, Salt Lake City, Utah 84143, USA. LDSGOODL@ihc.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10612321

Citation

Goodlin, S J., et al. "Factors Associated With Use of Cardiopulmonary Resuscitation in Seriously Ill Hospitalized Adults." JAMA, vol. 282, no. 24, 1999, pp. 2333-9.
Goodlin SJ, Zhong Z, Lynn J, et al. Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults. JAMA. 1999;282(24):2333-9.
Goodlin, S. J., Zhong, Z., Lynn, J., Teno, J. M., Fago, J. P., Desbiens, N., ... Phillips, R. S. (1999). Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults. JAMA, 282(24), pp. 2333-9.
Goodlin SJ, et al. Factors Associated With Use of Cardiopulmonary Resuscitation in Seriously Ill Hospitalized Adults. JAMA. 1999;282(24):2333-9. PubMed PMID: 10612321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults. AU - Goodlin,S J, AU - Zhong,Z, AU - Lynn,J, AU - Teno,J M, AU - Fago,J P, AU - Desbiens,N, AU - Connors,A F,Jr AU - Wenger,N S, AU - Phillips,R S, PY - 1999/12/28/pubmed PY - 2001/3/28/medline PY - 1999/12/28/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Hospitalized Elderly Longitudinal Project (HELP) KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - 2333 EP - 9 JF - JAMA JO - JAMA VL - 282 IS - 24 N2 - CONTEXT: The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). OBJECTIVE: To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. DESIGN: Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting Five teaching hospitals across the United States. PARTICIPANTS: A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. MAIN OUTCOME MEASURES: Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. RESULTS: Five hundred fourteen study subjects (21 %) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1 %) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60; 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. CONCLUSIONS: Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/10612321/Factors_associated_with_use_of_cardiopulmonary_resuscitation_in_seriously_ill_hospitalized_adults_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/282/pg/2333 DB - PRIME DP - Unbound Medicine ER -