CPR Survival Rates for the Elderly Unchanged

Despite our many efforts to fine tune the process for cardiopulmonary resuscitation, also known as CPR, the survival rate for the elderly who are given CPR has not changed very much in recent decades. According to a new study published in the July 2nd issue of the New England Journal of Medicine, only 18 percent of adults over the age of 65 who received CPR while they were in the hospital survived long enough to see their discharge day. However, during the study period—1992 through 2005—the number of people that were in this age group that received CPR before they died jumped from 3.8 percent to 5.2 percent, a 37 percent increase.

The study’s lead author, Dr. William Ehlenbach, who is a senior fellow at the University of Washington located in Seattle, said that although there have been significant efforts to help improve CPR, we have found that there is still no big change in the rate of survival. He also stated this may be due to a population that is sicker. “People are living longer with chronic disease. And, in people 65 and older, its more common to have multiple, serious chronic illnesses that are less survivable than an acute illness. CPR has the highest likelihood of success when the heart is the reason, as in an ongoing heart attack or a heart rhythm disturbance. If you’re otherwise doing well, CPR will often be successful.”

Another reason that the rates of survival with CPR have not improved, he stated, is because some people that are given CPR probably should not because it will not significantly extend their life and might even prolong their death and suffering. “People are very commonly surprised at the likelihood of survival after CPR. Doctors and other health-care providers need to have discussions about end-of-life care and the role of CPR in end-of-life care. This study highlights the need for improved education and communication about end-of-life care,” he concluded.

The researchers reviewed Medicare data on the people that are age 65 and older who were hospitalized between the years 1992 an 2005. They found that approximately 433,985 people were given in-hospital CPR during that time and that only 18.3 percent of the people survived until they were discharged.

The study also found that more black and other non-white patients were given CPR, but the survival rate was approximately 24 percent lower for black patients than for white patients. Ehlenbach said that the researchers were very surprised by this finding and they did further analysis to see whether the rate varied depending on the facility where they were hospitalized. In other words, the researchers were trying to find out if minorities that were receiving care in hospitals had lower rates for survival after being given CPR. The study found that the “difference seems to be a hospital effect.”

Dr. Daniel Brauner, who is an associate professor of geriatrics and palliative medicine at the University of Chicago Medical Center, stated that the disparities in health care could very well play a role in the differences in race that was found in the study, but that those differences could also indicate a need for increased communication and education.

“In this study, blacks are requesting almost twice the rate of CPR. They don’t want ‘do not resuscitate’ orders. The reasons for this are probably multifold. Some may not have had access to health care in the past, and now that they do, they want to make use of all of the technologies. The other part of it is a trust issue. You really have to be able to trust your physician [when you are making end-of-life care decisions].”

The study also found that the people who survived CPR were less likely to go home than in the past. Instead, more of them were transferred to long-term care facilities.

Brauner stated, “Sometimes it’s in your best interest to forego CPR. There is a burden that comes with getting these therapies. And, if you’re at the end stage of a chronic illness, CPR isn’t going to change that. There are much more pleasant ways to approach end-of-life care.”