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May 2012, Volume 42 Number 5 , p 14 - 15


  • Harleah G. Buck PhD, RN, CHPN


AS NURSES, most of us have experienced one of our patients "coding." No matter what the circumstances, you felt that surge of adrenaline that enables you to rapidly recognize an unresponsive, apneic patient, activate the resuscitation team, and provide basic life support until the team arrives. This is what nurses do-we save lives and so much more.But maybe you've also had this experience: After an unsuccessful resuscitation attempt, someone says, "He was 90 years old with metastatic cancer. What were we thinking?" It leaves us with the uneasy feeling that something should be different.End-of-life decision making is always difficult and should be well thought out before a crisis. The decision to forgo CPR can be one of the hardest decisions a patient or family member has to make.Writing to me about end-of-life concerns, one of you asked for "good, solid statistics about CPR in older adults" and requested some resources for family members. Evidence-based nursing is built upon examining the research, so I searched for pertinent studies that provided those "good solid statistics." Here's what I found.A large epidemiologic study of more than 400,000 hospitalized Medicare patients (in other words, patients who were age 65 or older) found that approximately 18% of patients who experienced in-hospital CPR survived to discharge.1 In other words, less than one older adult out of five survived. Some factors were associated with an even lower survival rate: male gender, more advanced age, more chronic comorbidities, Black or other non-White race, and admission from skilled nursing facilities.This study looked at data from 1992 to 2005, a time when healthcare was making great strides in improving outcomes for patients. And yet survival rates after CPR didn't improve-indeed, while the incidence of in-house CPR remained about the same during the 13 years studied, the proportion of survivors decreased. The authors note several study limitations that should be considered when interpreting

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