THE ASSOCIATION BETWEEN AGE OF HOSPITALIZED-PATIENTS AND THE DELIVERYOF ADVANCED CARDIAC LIFE-SUPPORT

OBJECTIVE: To determine the extent of variability in the administratio n of advanced cardiac life support (ACLS) and to determine if age is a ssociated with variability. DESIGN: Retrospective cohort. SETTING: Urb an teaching hospital. PATIENTS: One hundred twenty-two adult inpatient s without a ''do-not-resuscitate'' order who suffered cardiopulmonary arrest during 1993. MEASUREMENTS AND MAIN RESULTS: Of the total, 35 (2 9%) survived the arrest and 87 (71%) died. Among the nonsurvivors, two patients received no ACLS and six were not intubated, despite the inc lusion of intubation in all ACLS protocols. Of the 87 nonsurvivors, 31 had a single electrocardiographic rhythm during their arrest and shou ld have had similar ACLS trials. However, the 9 nonsurvivors with vent ricular fibrillation received a range of 0 to 17 interventions, the 11 with electromechanical dissociation received 1 to 22, and the 11 with asystole received 9 to 14. Based on a protocol-derived definition of a minimal trial of ACLS (a ''short ACLS trial'') for all 87 nonsurvivo rs, age greater than 75 was associated with receiving a short trial. D ependent functional status and being on a medical service were also as sociated with a short ACLS trial. In a logistic regression model inclu ding these variables as covariates, age remained significantly associa ted with a short ACLS trial; odds ratio, 9.71 (95% confidence interval 1.68, 56.1). CONCLUSIONS: Wide variability exists in the administrati on of ACLS at the studied site. The finding that some patients receive no ACLS suggests that physicians at this site may be making bedside d eterminations of the likelihood of its benefit based on individual pat ient characteristics. The association between older age and short ACLS trials among all nonsurvivors suggests that age is most important of these characteristics.