Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians.
adults 80 and older
cardiopulmonary resuscitation
inappropriate care
nursing homes
out-of-hospital cardiac arrest
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
12
08
2019
revised:
29
08
2019
accepted:
05
09
2019
pubmed:
17
12
2019
medline:
15
8
2020
entrez:
17
12
2019
Statut:
ppublish
Résumé
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. Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. 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. 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. 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. J Am Geriatr Soc 68:39-45, 2019.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-45Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 The American Geriatrics Society.
Références
Mather M, Jacobsen LA, Pollard KM. Aging in the United States. Popul Bull. 2015;70(2):1-23.
European Commission. The 2018 Ageing Report: Underlying Assumptions and Projection Methodologies. European Commission Institutional Paper 065; Brussels: Economic and Financial Affairs; 2017:1-240. https://doi.org/10.2765/286359.
Population Projections for Japan: 2016 to 2065. National Institute of Population and Social Society Research. www.ipss.go.jp/pp-zenkoku/e/zenkoku_e2017/pp_zenkoku2017e.asp. Accessed July 12, 2019.
Libungan B, Lindqvist J, Strömsöe A, et al. Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study. Resuscitation. 2015;94:28-32.
Kitamura T, Iwami T, Kawamura T, et al. Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan. Circulation. 2012;126(24):2834-2843.
Terman SW, Shields TA, Hume B, Silbergleit R. The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest. Resuscitation. 2015;89:169-176.
Wissenberg M, Folke F, Hansen CM, et al. Survival after out-of-hospital cardiac arrest in relation to age and early identification of patients with minimal chance of long-term survival. Circulation. 2015;131(18):1536-1545.
Okabayashi S, Matsuyama T, Kitamura T, et al. Outcomes of patients 65 years or older after out-of-hospital cardiac arrest based on location of cardiac arrest in Japan. JAMA Netw Open. 2019;2(3):e191011-e191011.
Sulzgruber P, Sterz F, Poppe M, et al. Age-specific prognostication after out-of-hospital cardiac arrest-the ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly. Eur Heart J Acute Cardiovasc Care. 2017;6(2):112-120.
Frank C, Heyland DK, Chen B, Farquhar D, Myers K, Iwaasa K. Determining resuscitation preferences of elderly inpatients: a review of the literature. CMAJ. 2003;169(8):795-799.
O'Donnell H, Phillips RS, Wenger N, Teno J, Davis RB, Hamel MB. Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians. J Am Med Dir Assoc. 2003;4(3):139-144.
Anderson NE, Gott M, Slark J. Commence, continue, withhold or terminate?: a systematic review of decision-making in out-of-hospital cardiac arrest. Eur J Emerg Med. 2017;24(2):80-86.
Druwé P, Monsieurs KG, Piers R, et al. Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: the REAPPROPRIATE international, multi-centre, cross sectional survey. Resuscitation. 2018;132:112-119.
Piers RD, Azoulay E, Ricou B, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306(24):2694-2703.
Jones PS, Lee JW, Phillips LR, Zhang XE, Jaceldo KB. An adaptation of Brislin's translation model for cross-cultural research. Nurs Res. 2001;50(5):300-304.
Chan PS, McNally B, Tang F, Kellermann A, CARES Surveillance Group. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014;130(21):1876-1882.
Beesems SG, Blom MT, van der Pas MHA, et al. Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older. Resuscitation. 2015;94:33-39.
Brown SM, Azoulay E, Benoit D, et al. The practice of respect in the ICU. Am J Respir Crit Care Med. 2018;197(11):1389-1395.
Shibahashi K, Sugiyama K, Hamabe Y. A potential termination of resuscitation rule for EMS to implement in the field for out-of-hospital cardiac arrest: an observational cohort study. Resuscitation. 2018;130:28-32.
Grunau B, Scheuermeyer F, Kawano T, et al. North American validation of the Bokutoh criteria for withholding professional resuscitation in non-traumatic out-of-hospital cardiac arrest. Resuscitation. 2019;135:51-56.
Meier EA, Gallegos JV, Thomas LPM, Depp CA, Irwin SA, Jeste DV. Defining a good death (successful dying): literature review and a call for research and public dialogue. Am J Geriatr Psychiatry. 2016;24(4):261-271.
Marco CA, Larkin GL. Ethics seminars: case studies in “futility”-challenges for academic emergency medicine. Acad Emerg Med. 2000;7(10):1147-1151.
Rubulotta F, Rubulotta G. Cardiopulmonary resuscitation and ethics. Rev Bras Ter Intensiva. 2013;25(4):265-269.
Bossaert LL, Perkins GD, Askitopoulou H, et al. European resuscitation council guidelines for resuscitation 2015: section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015;95:302-311.
Marco CA, Bessman ES, Kelen GD. Ethical issues of cardiopulmonary resuscitation: comparison of emergency physician practices from 1995 to 2007. Acad Emerg Med. 2009;16(3):270-273.
Benoit DD, Jensen HI, Malmgren J, et al. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA. Intensive Care Med. 2018;44(7):1039-1049.
Evans N, Bausewein C, Meñaca A, et al. A critical review of advance directives in Germany: attitudes, use and healthcare professionals' compliance. Patient Educ Couns. 2012;87(3):277-288.
Pape M, Rajan S, Hansen SM, et al. Survival after out-of-hospital cardiac arrest in nursing homes-a nationwide study. Resuscitation. 2018;125:90-98.
Andrew E, Mercier E, Nehme Z, Bernard S, Smith K. Long-term functional recovery and health-related quality of life of elderly out-of-hospital cardiac arrest survivors. Resuscitation. 2018;126:118-124.
Fan KL, Leung LP. Outcomes of cardiac arrest in residential care homes for the elderly in Hong Kong. Prehosp Emerg Care. 2017;21((6)):709-714.