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

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dc.contributor.author REAPPROPRIATE Study Grp
dc.contributor.author Druwe, Patrick
dc.contributor.author Benoit, Dominique D.
dc.contributor.author Nurmi, Jouni
dc.contributor.author Piers, Ruth
dc.contributor.author Hallikainen, Juhana
dc.contributor.author Suonsyrja, Timo
dc.contributor.author Kaartinen, Johanna
dc.date.accessioned 2020-12-31T04:09:56Z
dc.date.available 2021-12-18T03:45:21Z
dc.date.issued 2020-01
dc.identifier.citation 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
dc.identifier.other PURE: 130361115
dc.identifier.other PURE UUID: 8a74e7f4-6615-4547-8d38-e5b97b8cc99c
dc.identifier.other WOS: 000502571300001
dc.identifier.uri http://hdl.handle.net/10138/323907
dc.description.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. en
dc.format.extent 7
dc.language.iso eng
dc.relation.ispartof Journal of the American Geriatrics Society
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject out-of-hospital cardiac arrest
dc.subject cardiopulmonary resuscitation
dc.subject adults 80 and older
dc.subject nursing homes
dc.subject inappropriate care
dc.subject HOSPITAL CARDIAC-ARREST
dc.subject OF-LIFE
dc.subject SURVIVAL
dc.subject AGE
dc.subject ETHICS
dc.subject CARE
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.title Cardiopulmonary Resuscitation in Adults Over 80 : Outcome and the Perception of Appropriateness by Clinicians en
dc.type Article
dc.contributor.organization HUS Emergency Medicine and Services
dc.contributor.organization Staff Services
dc.contributor.organization Clinicum
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization University of Helsinki
dc.contributor.organization Kimmo Kontula Research Group
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1111/jgs.16270
dc.relation.issn 0002-8614
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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