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CPR in elderly (worth a read)

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Take home point: when obtaining code-status on patients, ask them the following question.

“Would you be interested in hearing the statistics from people your age who underwent CPR?”

A 2014 study that compiled the results of thousands-of-smaller-studies of close to half-a-million patients showed that:
More than half of the patients who survived CPR eventually died before hospital discharge.
In an MBTA bus of 50 identical patients who are elderly and received in-hospital CPR:
for 70 to 79 years old: About 9 out of 50 survive CPR and leave the hospital
for 80 to 89 years old: About 8 out of 50 survive CPR and leave the hospital
for 90 years and older: About 6 out of 50 survive CPR and leave the hospital
Data on social and functional outcome after surviving CPR were scarce and contradictory.

MBTA bus

Only about six to nine of you are getting off this bus before its final destination.”
(Disclaimer: this graphic is solely to illustrate the statistic, NOT to include in the counseling of your patients!)

Van Gijn, MS., et al. (2014) The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age and Ageing. 43: 456–463

Abstract
Background: physicians are frequently confronted with the question whether cardiopulmonary resuscitation (CPR) is a medically appropriate treatment for older people. For physicians, patients and relatives, it is important to know the chance of survival and the functional outcome after CPR in order to make an informed decision.
Methods: a systematic search was performed in MEDLINE, Embase and Cochrane up to November 2012. Studies that were included described the chance of survival, the social status and functional outcome after in-hospital CPR in older people aged 70 years and above.
Results: we identified 11,377 publications of which 29 were included in this review; 38.6% of the patients who were 70 years and older had a return of spontaneous circulation. More than half of the patients who initially survived resuscitation died in the hospital before hospital discharge. The pooled survival to discharge after in-hospital CPR was 18.7% for patients between 70 and 79 years old, 15.4% for patients between 80 and 89 years old and 11.6% for patients of 90 years and older. Data on social and functional outcome after surviving CPR were scarce and contradictory.
Conclusions: the chance of survival to hospital discharge for in-hospital CPR in older people is low to moderate (11.6– 18.7%) and decreases with age. However, evidence about functional or social outcomes after surviving CPR is scarce. Prospective studies are needed to address this issue and to identify pre-arrest factors that can predict survival in the older people in order to define subgroups that could benefit from CPR.
Keywords: CPR, geriatrics, inpatient, prognosis, systematic review, elderly

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One thought on “CPR in elderly (worth a read)

  1. There’s a similar study quoted by a Hospitalist, Dr RW Donnell in his blog:
    http://doctorrw.blogspot.com/2014/11/meta-analysis-on-neurologic-prognosis.html

    “Three tests accurately predicted poor neurologic outcome with low false-positive rates:
    1) bilateral absence of pupillary reflexes more than 24 hours after a return of spontaneous circulation (false-positive rate, 0.02; 95% CI, 0.01–0.06; summary positive likelihood ratio, 10.45; 95% CI, 3.37–32.43),
    2) bilateral absence of corneal reflexes more than 24 hours (false-positive rate, 0.04; 95% CI, 0.01–0.09; positive likelihood ratio, 6.8; 95% CI, 2.52–18.38), and 3) bilateral absence of somatosensory-evoked potentials between days 1 and 7 (false-positive rate, 0.03; 95% CI, 0.01–0.07; positive likelihood ratio, 12.79; 95% CI, 5.35–30.62)”

    Of these tests,
    Pupillary reflexes and corneal reflexes are the easiest to do at the bedside and have a “false-positive rate” of 0.02 and 0.03 respectively. However, if a family member asks me “What are the chances that my loved one will recover, in spite of the odds and the tests you did?”… we would need to weight this information agains the True positive rate and False negative rate to get our Positive predictive value and our Negative predictive value.

    Saying “I am 97-98% certain” is not the most accurate answer you could provide in this situation, despite what basic numeracy would “intuitively” imply.

    http://en.wikipedia.org/wiki/Positive_and_negative_predictive_values

    Like

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