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Factors Associated With Use of Cardiopulmonary Resuscitation in Seriously Ill Hospitalized Adults
Sarah J. Goodlin, MD;
Zhenshao Zhong, PhD;
Joanne Lynn, MD, MS, MA;
Joan M. Teno, MD, MS;
Julie P. Fago, MD;
Norman Desbiens, MD;
Alfred F. Connors, Jr, MD;
Neil S. Wenger, MD;
Russell S. Phillips, MD
JAMA. 1999;282:2333-2339.
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.
Author Affiliations: Division of Geriatrics, LDS Hospital, Salt Lake City, Utah (Dr Goodlin); Center to Improve Care of the Dying, George Washington University, Washington, DC (Drs Zhong and Lynn); Center for Gerontology and Health Care Research, Brown University, Providence, RI (Dr Teno); Department of Medicine, Dartmouth Medical School, Hanover, NH (Dr Fago); University of Tennessee, College of Medicine, Chattanooga Unit, Chattanooga (Dr Desbiens); Department of Medicine, University of Virginia, Charlottesville (Dr Connors); Department of Medicine, University of California at Los Angeles (Dr Wenger); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass (Dr Phillips). Dr Goodlin is a Faculty Scholar, Open Society Institute, Project on Death in America, New York, NY.
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