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

Context The epidemiology of do-not-resuscitate (DNR) orders for hospitalize d 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 patient s 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 Longitudina l Project (HELP, 1994). Setting Five teaching hospitals across the United States. Participants A total of 2505 seriously ill hospitalized patients and nonele ctively admitted persons aged 80 years or older who experienced cardiopulmo nary arrest. Main Outcome Measures Medical records data on CPR efforts, DNR orders, dise ase severity, age, race, sex, length of stay, and survival; functional stat us and preferences concerning CPR obtained by interviews with patients or s urrogates; and 2-month survival estimates provided by physicians. Results Five hundred fourteen study subjects (21%) received CPR during thei r index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of d eath and 93 (18.1%) had resuscitation and survived their index hospitalizat ion. Use of CPR was more likely in men (odds ratio [OR], 1.39; 95% confiden ce 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), pa tients 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 wh o 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 locat ion and diagnosis; the adjusted OR for patients with congestive heart failu re was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respirato ry failure or multiple organ system failure. Conclusions Our data suggest that a resuscitation attempt is more likely wh en preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patient s with different diagnoses, race,sex, or age.