Data Reveal Surprising Trends in In-Hospital CPR
By Mary Ann Moon
Elsevier Global Medical News
Among elderly patients, survival after in-hospital CPR has not improved in recent years, according to a report in the New England Journal of Medicine.
The proportion of inpatient deaths preceded by CPR has risen, while the proportion of survivors discharged after undergoing CPR has dropped. This may indicate a worrisome trend "toward poorer neurologic and functional outcomes among patients undergoing CPR who survive to discharge," wrote Dr. William J. Ehlenbach of Harborview Medical Center, Seattle, and his associates.
The researchers performed an epidemiologic study of in-hospital CPR among Medicare beneficiaries aged 65 and older, noting, "It is unclear whether advances in CPR or in care after cardiac arrest have improved outcomes after in-hospital arrest."
They reviewed claims data from 433,985 subjects who underwent CPR while hospitalized in 1992-2005.
Overall, just 18.3% of these patients survived to hospital discharge. The incidence of in-hospital CPR did not change during the study period. However, the incidence of death after in-hospital CPR rose from 3.8% in 1992 to 5.2% in 2005, an increase of nearly 40% (N. Engl. J. Med. 2009;361:22-31).
That finding is of particular concern because the data were collected "during a time of more education and awareness about the limits of CPR in patients with advanced chronic illness and life-threatening acute disease," they added.
This epidemiologic study could not determine the reasons for the increase in post-CPR deaths, nor for the finding that the proportion of survivors discharged to other hospitals, skilled nursing care, or hospices rather than home increased significantly.
No potential conflicts of interest were reported.