Cardiac arrest: giving information on survival reduced the number of old patients who wanted to be resuscitated

Clinical bottom line (level 4)

  1. A quarter of elderly patients did not want cardiopulmonary resuscitation.
  2. A fifth want cardiopulmonary resuscitation even if the survival rate was less than 10%.
  3. Discussing survival rate following cardiac arrest reduced the number of elderly patients who wanted to be resuscitated.
Murphy et al: New England Journal of Medicine 1994; 330 (8): 545-549
Expires October 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: geriatric practice, USA

287 patients (aged 60 to 99; mean 77, 65% female)

Excluded if
  • language problems
  • incomplete interview
  • dementia
  • psychiatric problems
  • acute medical problems


    • All patients were given information about cardiopulmonary resuscitation. Patients were then shown pie charts depicting probability of survival following cardiac arrest, and asked whether they wanted CPR at that probability..


    Outcomes studied:
  • wanted CPR before discussion
  • wanted CPR after discussion
  • did not want CPR
  • wanted CPR if 1% survival
  • wanted CPR if 5 to 10% survival
  • wanted CPR if 20 to 40% survival
  • wanted CPR if 50% survival
  • wanted CPR if > 60% survival

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    wanted CPR before discussion ? 118/287 41.11%
    (35.42% to 46.81%)
    wanted CPR after discussion ? 63/287 21.95%
    (17.162% to 26.74%)
    did not want CPR ? 71/287 24.74%
    (20% to 30%)
    wanted CPR if 1% survival ? 28/287 9.8%
    (6.3% to 13.2%)
    wanted CPR if 5 to 10% survival ? 28/287 9.8%
    (6.3% to 13.2%)
    wanted CPR if 20 to 40% survival ? 64/287 22.3%
    (17.5% to 27.1%)
    wanted CPR if 50% survival ? 72/287 25.1%
    (20.1% to 30.1%)
    wanted CPR if > 60% survival ? 24/287 8.4%
    (5.2% to 11.6%)

    Comments

    1. Around 10 to 17% of elderly patients leave hospital alive following a cardiac arrest.

    Citation

    1. Murphy DJ, Burrows D, Santilli S, et al: The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. New England Journal of Medicine 1994; 330 (8): 545-549
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient elderly
    Intervention or Exposure discussion about survival following cardiac arrest and CPR
    Outcome survival to leave hospital