Factors associated with use of cardiopulmonary resuscitation in seriously III hospitalized adults

Sarah Goodlin, Zhenshao Zhong, Joanne Lynn, Joan Teno, Julie P. Fago, Norman Desbiens, Alfred F. Connors, Neil S. Wenger, Russell S. Phillips

Research output: Contribution to journalArticle

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Abstract

Context. The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). Objective. To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. Design. Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting. Five teaching hospitals across the United States. Participants. A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. Main Outcome Measures. Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. Results. Five hundred fourteen study subjects (21%) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1%) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ration [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60, 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. Conclusions. Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.

Original languageEnglish (US)
Pages (from-to)2333-2339
Number of pages7
JournalJournal of the American Medical Association
Volume282
Issue number24
StatePublished - Dec 22 1999
Externally publishedYes

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Cardiopulmonary Resuscitation
Confidence Intervals
Resuscitation Orders
Heart Arrest
Resuscitation
Survival
Hospitalization
Physicians
Geographic Locations
Multiple Organ Failure
Teaching Hospitals
Respiratory Insufficiency
African Americans
Medical Records
Length of Stay
Epidemiology
Cohort Studies
Heart Failure
Quality of Life
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Factors associated with use of cardiopulmonary resuscitation in seriously III hospitalized adults. / Goodlin, Sarah; Zhong, Zhenshao; Lynn, Joanne; Teno, Joan; Fago, Julie P.; Desbiens, Norman; Connors, Alfred F.; Wenger, Neil S.; Phillips, Russell S.

In: Journal of the American Medical Association, Vol. 282, No. 24, 22.12.1999, p. 2333-2339.

Research output: Contribution to journalArticle

Goodlin, S, Zhong, Z, Lynn, J, Teno, J, Fago, JP, Desbiens, N, Connors, AF, Wenger, NS & Phillips, RS 1999, 'Factors associated with use of cardiopulmonary resuscitation in seriously III hospitalized adults', Journal of the American Medical Association, vol. 282, no. 24, pp. 2333-2339.
Goodlin, Sarah ; Zhong, Zhenshao ; Lynn, Joanne ; Teno, Joan ; Fago, Julie P. ; Desbiens, Norman ; Connors, Alfred F. ; Wenger, Neil S. ; Phillips, Russell S. / Factors associated with use of cardiopulmonary resuscitation in seriously III hospitalized adults. In: Journal of the American Medical Association. 1999 ; Vol. 282, No. 24. pp. 2333-2339.
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abstract = "Context. The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). Objective. To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. Design. Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting. Five teaching hospitals across the United States. Participants. A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. Main Outcome Measures. Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. Results. Five hundred fourteen study subjects (21{\%}) received CPR during their index hospitalization. Among them, 327 (63.6{\%}) had CPR within 2 days of death and 93 (18.1{\%}) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ration [OR], 1.39; 95{\%} confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95{\%} CI, 0.84-0.96), African Americans (OR, 1.76; 95{\%} CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60, 95{\%} CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95{\%} CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10{\%} increase, 1.14; 95{\%} CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95{\%} CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. Conclusions. Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.",
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AU - Zhong, Zhenshao

AU - Lynn, Joanne

AU - Teno, Joan

AU - Fago, Julie P.

AU - Desbiens, Norman

AU - Connors, Alfred F.

AU - Wenger, Neil S.

AU - Phillips, Russell S.

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N2 - Context. The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). Objective. To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. Design. Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting. Five teaching hospitals across the United States. Participants. A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. Main Outcome Measures. Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. Results. Five hundred fourteen study subjects (21%) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1%) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ration [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60, 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. Conclusions. Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.

AB - Context. The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). Objective. To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. Design. Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting. Five teaching hospitals across the United States. Participants. A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. Main Outcome Measures. Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. Results. Five hundred fourteen study subjects (21%) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1%) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ration [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60, 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. Conclusions. Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.

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