Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly
William J Ehlenbach, Amber E Barnato, J Randall Curtis, William Kreuter, Thomas D Koepsell, Richard A Deyo, Renee D Stapleton, William J Ehlenbach, Amber E Barnato, J Randall Curtis, William Kreuter, Thomas D Koepsell, Richard A Deyo, Renee D Stapleton
Abstract
Background: It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.
Methods: We examined fee-for-service Medicare data from 1992 through 2005 to identify beneficiaries 65 years of age or older who underwent CPR in U.S. hospitals. We examined temporal trends in the incidence of CPR and the rate of survival after CPR, as well as patient- and hospital-level predictors of survival to discharge.
Results: We identified 433,985 patients who underwent in-hospital CPR; 18.3% of these patients (95% confidence interval [CI], 18.2 to 18.5) survived to discharge. The rate of survival did not change substantially during the period from 1992 through 2005. The overall incidence of CPR was 2.73 events per 1000 admissions; the incidence was higher among black and other nonwhite patients. The proportion of patients undergoing in-hospital CPR before death increased over time and was higher for nonwhite patients. The survival rate was lower among patients who were men, were older, had more coexisting illnesses, or were admitted from a skilled-nursing facility. The adjusted odds of survival for black patients were 23.6% lower than those for similar white patients (95% CI, 21.2 to 25.9). The association between race and survival was partially explained by hospital effects: black patients were more likely to undergo CPR in hospitals that have lower rates of post-CPR survival. Among patients surviving in-hospital CPR, the proportion of patients discharged home rather than to a health care facility decreased over time.
Conclusions: Survival after in-hospital CPR did not improve from 1992 through 2005. The proportion of in-hospital deaths preceded by CPR increased, whereas the proportion of survivors discharged home after undergoing CPR decreased. Black race was associated with higher rates of CPR but lower rates of survival after CPR.
2009 Massachusetts Medical Society
Figures
![Figure 1. Survival to Hospital Discharge Following…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2917337/bin/nihms-213183-f0001.jpg)
![Figure 2. Trends in CPR Utilization, by…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2917337/bin/nihms-213183-f0002.jpg)
Figure 2. Trends in CPR Utilization, by…
Figure 2. Trends in CPR Utilization, by Race
A. Incidence of in-hospital CPR. The incidence…
Figure 3. Trends in Discharge Destination of…
Figure 3. Trends in Discharge Destination of Survivors of In-Hospital CPR
Patients discharged home with…
- In-hospital cardiopulmonary resuscitation.Wallace CK. Wallace CK. N Engl J Med. 2009 Oct 22;361(17):1708; author reply 1708-9. doi: 10.1056/NEJMc091552. N Engl J Med. 2009. PMID: 19846860 No abstract available.
- In-hospital cardiopulmonary resuscitation.Brauner DJ, Grusin SL. Brauner DJ, et al. N Engl J Med. 2009 Oct 22;361(17):1708; author reply 1708-9. N Engl J Med. 2009. PMID: 19860012 No abstract available.
- Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.Hayashi T, Matsushima M, Bito S, Kanazawa N, Inoue N, Luthe SK, Wee CC. Hayashi T, et al. J Gen Intern Med. 2019 Feb;34(2):206-210. doi: 10.1007/s11606-018-4747-5. Epub 2018 Nov 27. J Gen Intern Med. 2019. PMID: 30484100 Free PMC article.
- Effect of race on survival following in-hospital cardiopulmonary resuscitation.Ebell MH, Smith M, Kruse JA, Drader-Wilcox J, Novak J. Ebell MH, et al. J Fam Pract. 1995 Jun;40(6):571-7. J Fam Pract. 1995. PMID: 7775911
- Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.Kazaure HS, Roman SA, Sosa JA. Kazaure HS, et al. Resuscitation. 2013 Sep;84(9):1255-60. doi: 10.1016/j.resuscitation.2013.02.021. Epub 2013 Mar 5. Resuscitation. 2013. PMID: 23470471
- Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis.Wong SP, Kreuter W, Curtis JR, Hall YN, O'Hare AM. Wong SP, et al. JAMA Intern Med. 2015 Jun;175(6):1028-35. doi: 10.1001/jamainternmed.2015.0406. JAMA Intern Med. 2015. PMID: 25915762 Free PMC article.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States.Olanipekun T, Abe T, Chris-Olaiya A, Effoe VS, Bhardwaj A, Harrison MF, Moreno Franco P, Guru P, Sanghavi D. Olanipekun T, et al. Crit Care Explor. 2023 Jan 9;5(1):e0838. doi: 10.1097/CCE.0000000000000838. eCollection 2023 Jan. Crit Care Explor. 2023. PMID: 36699243 Free PMC article.
- Associations between dementia diagnosis and end-of-life care utilization.Luth EA, Manful A, Prigerson HG, Xiang L, Reich A, Semco R, Weissman JS. Luth EA, et al. J Am Geriatr Soc. 2022 Oct;70(10):2871-2883. doi: 10.1111/jgs.17952. Epub 2022 Jul 13. J Am Geriatr Soc. 2022. PMID: 35822659 Free PMC article.
- Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest.Stærk M, Lauridsen KG, Niklassen J, Nielsen RP, Krogh K, Løfgren B. Stærk M, et al. Resusc Plus. 2022 Jun 2;10:100257. doi: 10.1016/j.resplu.2022.100257. eCollection 2022 Jun. Resusc Plus. 2022. PMID: 35677834 Free PMC article.
- Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients.Stapleton RD, Ford DW, Sterba KR, Nadig NR, Ades S, Back AL, Carson SS, Cheung KL, Ely J, Kross EK, Macauley RC, Maguire JM, Marcy TW, McEntee JJ, Menon PR, Overstreet A, Ritchie CS, Wendlandt B, Ardren SS, Balassone M, Burns S, Choudhury S, Diehl S, McCown E, Nielsen EL, Paul SR, Rice C, Taylor KK, Engelberg RA. Stapleton RD, et al. J Pain Symptom Manage. 2022 Jun;63(6):e621-e632. doi: 10.1016/j.jpainsymman.2022.03.009. J Pain Symptom Manage. 2022. PMID: 35595375
- Trends in In-Hospital Cardiopulmonary Resuscitation from 2010 through 2019: A Nationwide Cohort Study in South Korea.Oh TK, Jo YH, Song IA. Oh TK, et al. J Pers Med. 2022 Mar 1;12(3):377. doi: 10.3390/jpm12030377. J Pers Med. 2022. PMID: 35330377 Free PMC article.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Aged
- Aged, 80 and over
- Cardiopulmonary Resuscitation / mortality*
- Cardiopulmonary Resuscitation / trends
- Female
- Hospices / trends
- Hospital Mortality / trends
- Hospitalization
- Humans
- Incidence
- Logistic Models
- Male
- Medicare
- Racial Groups
- Socioeconomic Factors
- Survival Rate / trends*
- United States / epidemiology
- T32 HL 007287/HL/NHLBI NIH HHS/United States
- P20 RR015557-097006/RR/NCRR NIH HHS/United States
- 8K12RR023265/RR/NCRR NIH HHS/United States
- P20 RR015557/RR/NCRR NIH HHS/United States
- K08 AG021921-05/AG/NIA NIH HHS/United States
- T32 HL007287/HL/NHLBI NIH HHS/United States
- T32 HL007287-31/HL/NHLBI NIH HHS/United States
- K12 RR023265-02/RR/NCRR NIH HHS/United States
- K12 RR023265/RR/NCRR NIH HHS/United States
- 5P20RR015557/RR/NCRR NIH HHS/United States
- K08AG021921/AG/NIA NIH HHS/United States
- K08 AG021921/AG/NIA NIH HHS/United States
- Full Text Sources
- Other Literature Sources
- Medical
NCBI Literature Resources
The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
![Figure 2. Trends in CPR Utilization, by…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2917337/bin/nihms-213183-f0003.jpg)
Figure 3. Trends in Discharge Destination of…
Figure 3. Trends in Discharge Destination of Survivors of In-Hospital CPR
Patients discharged home with…
- In-hospital cardiopulmonary resuscitation.Wallace CK. Wallace CK. N Engl J Med. 2009 Oct 22;361(17):1708; author reply 1708-9. doi: 10.1056/NEJMc091552. N Engl J Med. 2009. PMID: 19846860 No abstract available.
- In-hospital cardiopulmonary resuscitation.Brauner DJ, Grusin SL. Brauner DJ, et al. N Engl J Med. 2009 Oct 22;361(17):1708; author reply 1708-9. N Engl J Med. 2009. PMID: 19860012 No abstract available.
- Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.Hayashi T, Matsushima M, Bito S, Kanazawa N, Inoue N, Luthe SK, Wee CC. Hayashi T, et al. J Gen Intern Med. 2019 Feb;34(2):206-210. doi: 10.1007/s11606-018-4747-5. Epub 2018 Nov 27. J Gen Intern Med. 2019. PMID: 30484100 Free PMC article.
- Effect of race on survival following in-hospital cardiopulmonary resuscitation.Ebell MH, Smith M, Kruse JA, Drader-Wilcox J, Novak J. Ebell MH, et al. J Fam Pract. 1995 Jun;40(6):571-7. J Fam Pract. 1995. PMID: 7775911
- Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.Kazaure HS, Roman SA, Sosa JA. Kazaure HS, et al. Resuscitation. 2013 Sep;84(9):1255-60. doi: 10.1016/j.resuscitation.2013.02.021. Epub 2013 Mar 5. Resuscitation. 2013. PMID: 23470471
- Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis.Wong SP, Kreuter W, Curtis JR, Hall YN, O'Hare AM. Wong SP, et al. JAMA Intern Med. 2015 Jun;175(6):1028-35. doi: 10.1001/jamainternmed.2015.0406. JAMA Intern Med. 2015. PMID: 25915762 Free PMC article.
- Suicidal Ideation.Harmer B, Lee S, Duong TVH, Saadabadi A. Harmer B, et al. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 33351435 Free Books & Documents.
- Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States.Olanipekun T, Abe T, Chris-Olaiya A, Effoe VS, Bhardwaj A, Harrison MF, Moreno Franco P, Guru P, Sanghavi D. Olanipekun T, et al. Crit Care Explor. 2023 Jan 9;5(1):e0838. doi: 10.1097/CCE.0000000000000838. eCollection 2023 Jan. Crit Care Explor. 2023. PMID: 36699243 Free PMC article.
- Associations between dementia diagnosis and end-of-life care utilization.Luth EA, Manful A, Prigerson HG, Xiang L, Reich A, Semco R, Weissman JS. Luth EA, et al. J Am Geriatr Soc. 2022 Oct;70(10):2871-2883. doi: 10.1111/jgs.17952. Epub 2022 Jul 13. J Am Geriatr Soc. 2022. PMID: 35822659 Free PMC article.
- Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest.Stærk M, Lauridsen KG, Niklassen J, Nielsen RP, Krogh K, Løfgren B. Stærk M, et al. Resusc Plus. 2022 Jun 2;10:100257. doi: 10.1016/j.resplu.2022.100257. eCollection 2022 Jun. Resusc Plus. 2022. PMID: 35677834 Free PMC article.
- Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients.Stapleton RD, Ford DW, Sterba KR, Nadig NR, Ades S, Back AL, Carson SS, Cheung KL, Ely J, Kross EK, Macauley RC, Maguire JM, Marcy TW, McEntee JJ, Menon PR, Overstreet A, Ritchie CS, Wendlandt B, Ardren SS, Balassone M, Burns S, Choudhury S, Diehl S, McCown E, Nielsen EL, Paul SR, Rice C, Taylor KK, Engelberg RA. Stapleton RD, et al. J Pain Symptom Manage. 2022 Jun;63(6):e621-e632. doi: 10.1016/j.jpainsymman.2022.03.009. J Pain Symptom Manage. 2022. PMID: 35595375
- Trends in In-Hospital Cardiopulmonary Resuscitation from 2010 through 2019: A Nationwide Cohort Study in South Korea.Oh TK, Jo YH, Song IA. Oh TK, et al. J Pers Med. 2022 Mar 1;12(3):377. doi: 10.3390/jpm12030377. J Pers Med. 2022. PMID: 35330377 Free PMC article.
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Aged
- Aged, 80 and over
- Cardiopulmonary Resuscitation / mortality*
- Cardiopulmonary Resuscitation / trends
- Female
- Hospices / trends
- Hospital Mortality / trends
- Hospitalization
- Humans
- Incidence
- Logistic Models
- Male
- Medicare
- Racial Groups
- Socioeconomic Factors
- Survival Rate / trends*
- United States / epidemiology
- T32 HL 007287/HL/NHLBI NIH HHS/United States
- P20 RR015557-097006/RR/NCRR NIH HHS/United States
- 8K12RR023265/RR/NCRR NIH HHS/United States
- P20 RR015557/RR/NCRR NIH HHS/United States
- K08 AG021921-05/AG/NIA NIH HHS/United States
- T32 HL007287/HL/NHLBI NIH HHS/United States
- T32 HL007287-31/HL/NHLBI NIH HHS/United States
- K12 RR023265-02/RR/NCRR NIH HHS/United States
- K12 RR023265/RR/NCRR NIH HHS/United States
- 5P20RR015557/RR/NCRR NIH HHS/United States
- K08AG021921/AG/NIA NIH HHS/United States
- K08 AG021921/AG/NIA NIH HHS/United States
- Full Text Sources
- Other Literature Sources
- Medical
![Figure 3. Trends in Discharge Destination of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2917337/bin/nihms-213183-f0004.jpg)
Source: PubMed