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Fewer than 1 in 5 elders survive in-hospital CPR

Clinical Question:
What are the outcomes of cardiopulmonary resuscitation in hospitalized elders?

Bottom Line:
In general, hospitalized elders undergoing cardiopulmonary resuscitation (CPR) have an approximately 1 in 5 chance of surviving to hospital discharge. Among those who survive, nearly 80% will die in the following year. There is very little data about the functional outcomes of CPR and whether the elders are able to return to the community. (LOE = 2a)

Reference:
van Gijn MS, Frijns D, van de Glind EM, van Munster BC, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing 2014;43(4):456-463.  [PMID:24760957]

Study Design:
Systematic review

Funding:
Unknown/not stated

Setting:
Inpatient (ward only)

Synopsis:
These authors searched several databases to find studies that described outcomes, including social status and functional outcome, of hospitalized elderly patients undergoing CPR. A single author screened all potential studies for possible inclusion and 2 authors independently determined their inclusion. Similarly, 2 authors independently assessed the quality of the included studies and a third member of the team resolved all disagreements. They ultimately included 29 studies with more than 400,000 hospitalized elders. The majority of studies were of fair quality. Ten studies reported that approximately 39% of elders had return of spontaneous circulation (range = 21% - 58%). The rate of survival to hospital discharge for patients aged between 70 years and 79 years was 19% (range = 8% - 36%); for those aged 80 to 89 years, 15% (range = 4% - 31%); and for elders older than 90 years,12% (range = 0 - 50%). Overall, more than half of patients who survived the CPR died before discharge. Only 5 small studies assessed what happened to those patients more than 6 months after hospital discharge: Between 7% and 20% were still alive after 1 year. These data are similar to the results from other systematic reviews that evaluated CPR outcomes in more diverse age groups and settings.

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