Cardiopulmonary Resuscitation in Adults Over 80 : Outcome and the Perception of Appropriateness by Clinicians

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REAPPROPRIATE Study Grp , Druwe , P , Benoit , D D , Nurmi , J , Piers , R , Hallikainen , J , Suonsyrja , T & Kaartinen , J 2020 , ' Cardiopulmonary Resuscitation in Adults Over 80 : Outcome and the Perception of Appropriateness by Clinicians ' , Journal of the American Geriatrics Society , vol. 68 , no. 1 , pp. 39-45 . https://doi.org/10.1111/jgs.16270

Title: Cardiopulmonary Resuscitation in Adults Over 80 : Outcome and the Perception of Appropriateness by Clinicians
Author: REAPPROPRIATE Study Grp; Druwe, Patrick; Benoit, Dominique D.; Nurmi, Jouni; Piers, Ruth; Hallikainen, Juhana; Suonsyrja, Timo; Kaartinen, Johanna
Contributor organization: HUS Emergency Medicine and Services
Staff Services
Clinicum
Department of Diagnostics and Therapeutics
University of Helsinki
Kimmo Kontula Research Group
Date: 2020-01
Language: eng
Number of pages: 7
Belongs to series: Journal of the American Geriatrics Society
ISSN: 0002-8614
DOI: https://doi.org/10.1111/jgs.16270
URI: http://hdl.handle.net/10138/323907
Abstract: OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts.
Subject: out-of-hospital cardiac arrest
cardiopulmonary resuscitation
adults 80 and older
nursing homes
inappropriate care
HOSPITAL CARDIAC-ARREST
OF-LIFE
SURVIVAL
AGE
ETHICS
CARE
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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