An editorial written by DCRI faculty discusses resuscitation, which may not always be the best option for older adults because of poor survival rates.
Resuscitation after out-of-hospital cardiac arrest should not be administered using a one-size-fits-all approach, especially when treating older patients, according to an editorial in Journal of the American Geriatrics Society.
The editorial, written by the DCRI’s Monique Starks, MD, MHS (pictured left), and Karen Alexander, MD (pictured right), accompanies a published study led by Patrick Druwe, MD, of Ghent University Hospital in Belgium. Druwe’s study, which surveyed clinicians about their perceptions of recent resuscitations of patients over 80 years old, found that more than half believed the cardiopulmonary resuscitation (CPR) was appropriate, despite very low survival rates for this population.
Patients older than 80 tend to be frailer and have more comorbidities that put them at higher risk for negative outcomes, Starks and Alexander write. Although they acknowledge the study may have been influenced by response bias and missing data, they point out that other studies have also shown poor survival rates for older adults after out-of-hospital cardiac arrest. Beyond survival, other factors should be important considerations in deciding whether to administer CPR, such as maintaining meaningful cognition and physical function for these patients.
Although “the time‐sensitive nature of out-of-hospital cardiac arrest makes it extremely difficult to create a solution that can be nuanced and patient oriented in the field,” the authors suggest three considerations that could help in decision-making and reduce harm to older patients:
- Better physician‐patient communication about death and CPR;
- Increased use of out‐of‐hospital do‐not‐resuscitate orders; and
- “Starting rules” for CPR to avoid futile attempts at resuscitation in adults older than 80, such as in the event of unwitnessed arrests (when no one sees the patient go into cardiac arrest, thereby making it difficult to determine how long the patient has been in arrest), nonshockable rhythms (when the heart is not pumping), or in nursing home settings.
Starks was also interviewed by The New York Times on the topic, along with Druwe. “As a resuscitation researcher, I want to save everybody,” Starks told The New York Times. “But I think we’ve entered this zone where we’re trying to escape ordinary death.”