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Cardiopulmonary Resuscitation Outcomes in Hospitalized Community‐Dwelling Individuals and Nursing Home Residents Based on Activities of Daily Living
Author(s) -
Abbo Elmer D.,
Yuen Trevor C.,
Buhrmester Luke,
Geocadin Romergryko,
Volandes Angelo E.,
Siddique Juned,
Edelson Dana P.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12068
Subject(s) - medicine , interquartile range , cardiopulmonary resuscitation , odds ratio , return of spontaneous circulation , activities of daily living , confidence interval , resuscitation , odds , emergency medicine , logistic regression , physical therapy
Objectives To determine whether poor functional status is associated with worse outcomes after attempted cardiopulmonary resuscitation ( CPR ). Design Retrospective study of individuals who experienced cardiac arrest stratified according to dependence in activities of daily living ( ADL s) and residential status (nursing home ( NH ) or community dwelling). Setting Two hundred thirty‐five hospitals throughout N orth A merica. Participants Adult inpatients aged 65 and older who had experienced a cardiac arrest as reported to the Get with the G uidelines— R esuscitation registry between 2000 and 2008. Measurements Primary outcomes were return of spontaneous circulation ( ROSC ) and survival to discharge. Results Twenty‐six thousand three hundred twenty‐nine individuals who experienced cardiac arrest met inclusion criteria. NH residents dependent in ADL s had a lower odds than community‐dwelling independent participants of achieving ROSC (odds ratio ( OR ) = 0.73, 95% confidence interval ( CI ) = 0.63–0.85), whereas participants dependent in ADL s from either residential setting had lower odds of survival (community‐dwelling: OR = 0.76, 95% CI = 0.63–0.92; NH : OR = 0.79, 95% CI = 0.64–0.96) after adjusting for participant and arrest characteristics. Duration of resuscitation and doses of epinephrine or vasopressin were similar between groups and had no significant effect on ROSC or survival, although participants dependent in ADL s were more likely to have a do‐not‐resuscitate ( DNR ) order placed after ROSC . Overall, median time to signing a DNR order after resuscitation was 10 hours (interquartile range 2–70). Conclusion Functional and residential status are important predictors of survival after in‐hospital cardiac arrest. Contrary to the hypothesis but reassuring from a quality‐of‐care perspective, less‐aggressive attempts at resuscitation do not appear to contribute to poorer outcomes in individuals dependent in ADL , regardless of residential status.