One of the common expressions that doctors hear from elders and their family members when someone is hospitalized is “I want everything done that can be done”. One of their expectations is that cardio-pulmonary resuscitation will be carried out if the heart stops beating or the person stops breathing, and will most probably be successful at bringing them back to life. In point of fact, it is the law in many states that this procedure will be carried out unless the patient or their legal representative has opted out by signing a Do Not Resuscitate consent form.

Scant research has been done over the years in regard to the effectiveness of CPR but a new research study in Clinical Geriatrics in December 2009 by Alabi and Haines sheds some light on the survivability of CPR when carried out during hospitalization. A document called the Modified Pre-Arrest Morbidity Index was developed to sort out or stratify who is most and least likely to survive to hospital discharge after resuscitation has been performed.

Several factors negatively influence survivability. They include sepsis (system wide blood borne infection), cancer, advanced dementia, increased age (over 70), kidney and liver failure, stroke and congestive heart failure.

A monitored/witnessed cardiac arrest within 2 days of a heart attack offers the best chance of survival to discharge owing to the fact that the procedure is essentially about restoring electrical activity to the heart. Bear in mind that you only have 4 or 5 minutes after cardiac or respiratory arrest to apply CPR in order to avoid brain damage.

Long term care (LTC = nursing home) residents in general and nursing home patients with dementia in particular have the worst prognosis. While between 10% and 40% achieve immediate survival during the hospitalization only 3% survive to discharge. Unmonitored/unwitnessed arrest in or out of the hospital is the next best thing to a recipe for brain and organ damage.

Regardless of your personal feelings and beliefs, it is useful to have evidence based information available to assist you in your decision making about selection of health care proxies and whether or not you want advance directives such as a Do Not Resuscitate consent form  in place to guide your health care providers.

Alabi TO, Haines CA.  Predicting Survival From In-Hospital CPR.  Clinical Geriatrics 2009;17(12):34-36