A retrospective review of 399 cardiopulmonary resuscitation (CPR) efforts in 329 veterans was performed to evaluate the observation that few geriatric patients were discharged alive after they underwent CPR. Cardiopulmonary resuscitation efforts with witnessed arrests were more frequently successful than efforts with unwitnessed arrests (47.7% vs 29.9%) and resulted in live discharge more often than efforts with unwitnessed arrests. Cardiopulmonary resuscitation efforts that resulted in a live discharge were more brief and involved a lower mean number of medication doses. Of the 77 CPR efforts in patients 70 years of age or older who had arrests, 24 (31%) were successful, and in 22 (92%), patients were alive after 24 hours. None lived to discharge. There were 322 CPR efforts in the younger cohort; 137 (43%) were successful, in 124 (91%) of these 137 efforts, patients were alive after 24 hours, and in 22 (16%), patients were discharged alive. Older patients were significantly less likely to live to discharge both at the time of arrest and 24 hours after successful resuscitation. When a multivariate analysis was used, the presence of sepsis, cancer, increased age, increased number of medication doses administered, and absence of witness were all "predictive" of poor outcome. Cardiopulmonary resuscitation should be administered only to those who have the greatest potential benefit from this emotionally and physically traumatic procedure.
KIE: A review of 399 resuscitation efforts in 329 patients within one year at the Houston Veterans Administration Medical Center indicated that an age of 70 years or greater is associated with poor outcome after in-hospital cardiopulmonary resuscitation (CPR). Basing their conclusions on a detailed analysis of the methods and results of their study, the authors argue that CPR should be reserved for those who have a reasonable chance of survival until discharge, while admitting that the definition of this standard will vary. They recommend that patients 70 years or older, and patients with cancer or sepsis, should be identified as candidates for CPR only after considerable reflection by families and clinicians.