A new study published in the NEJM (July 2, 2009) looked at survival rates of the elderly who had cardiopulmonary resuscitation (CPR) performed on them while in the hospital between the years 1992 and 2005. The study was to determine if survival rates improved and which characteristics of both hospitals and patients increased the likelihood of survival.

The other significant finding was that black and nonwhite patients were more likely to undergo CPR in the hospital than whites. This again could partially be explained by the increasing severity of underlying health issues of black and nonwhite patients who reside in the community.

For me, this study underscores the need for frank discussions between family members about resuscitation wishes. One of the study findings suggest that “Do Not Resuscitate” (DNR) orders have either decreased or are not being followed. Those who did survive until discharge were more likely to end up in long-term care facilities or under hospice care. Not unexpectedly, poorer outcomes occurred in those with significant chronic illness (especially those who resided in nursing homes prior to their hospital admission).

The larger issue of quality of life for those who survived was not a focus of this study. These patients were not discharged back into their homes, suggesting they suffered from neurological and functional deficits that prohibited home return.

We can keep people with chronic illnesses alive for longer periods of time but when cardiac arrest occurs (especially in the very elderly) how aggressive should we be in performing CPR when the outcomes are much more likely to be poor?