Lack of improvement in death rates, experts say, may be because recipients are sicker,,,,
WEDNESDAY, July 1 (HealthDay News) -- Despite efforts to fine-tune the procedure for cardiopulmonary resuscitation, or CPR, the survival rate for older people given CPR has not changed much in recent decades, new research has found.
Just 18 percent of adults older than 65 who received CPR while in the hospital survived long enough to be discharged, according to a new study in the July 2 issue of the New England Journal of Medicine. However, during the study period, from 1992 to 2005, the number of people in this age group who were given CPR before they died jumped 37 percent -- from 3.8 percent in 1992 to 5.2 percent in 2005.
"Although significant efforts have been made to improve CPR, we found ... no significant change in survival," said the study's lead author, Dr. William Ehlenbach, a senior fellow at the University of Washington in Seattle.
That's probably because the population is sicker, he said.
"People are living longer with chronic disease," Ehlenbach said. "And, in people 65 and older, it's 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," he explained. "If you're otherwise doing well, CPR will often be successful. But, if you're in the ICU [intensive care unit] with a serious infection and multiple organ failure, it's unlikely that CPR will save you."
Another reason that CPR survival rates have not improved, he said, is that some people who are given CPR probably shouldn't be because it will not significantly extend their life and might prolong their death and suffering.
"People are very commonly surprised at the likelihood of survival after CPR," Ehlenbach said. "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."
The researchers reviewed Medicare data on people age 65 and older who were hospitalized between 1992 and 2005. They found that 433,985 people were given in-hospital CPR during that time and that 18.3 percent of them survived until discharged.
More black and other non-white patients were given CPR, the study found, but the survival rate was about 24 percent lower for black than for white patients. Ehlenbach said the researchers were somewhat surprised by this finding and did further analysis to see whether the rate varied depending on the facility where someone was hospitalized.
In other words, were minorities receiving care in hospitals that had lower rates of survival after CPR? The study found that the "difference seems to be a hospital effect," Ehlenbach said.
Dr. Daniel Brauner, an associate professor of geriatrics and palliative medicine at the University of Chicago Medical Center, said that disparities in health care might very well play a role in the racial differences found in the study, but that those differences also might indicate a need for increased education and communication.
"In this study, blacks are requesting almost twice the rate of CPR," Brauner said. "They don't want 'do not resuscitate' orders."
"The reasons for this are probably multifold," he said. "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 making end-of-life care decisions.
The study also found that people who survived CPR were less likely to go home than in the past. Instead, more were ransferred to longer-term care facilities.
"Sometimes it's in your best interest to forego CPR," Brauner said. "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."
The American Heart Association has more on CPR.
SOURCES: William J. Ehlenbach, M.D., M.Sc., senior fellow, University of Washington, Seattle; Daniel Brauner, M.D., associate professor, medicine, University of Chicago Medical Center, Chicago; July 2, 2009, New England Journal of Medicine
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