Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study

Abstract

Background: Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan. Objective: To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival. Design: Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016. Patients: We included elderly patients (age ≥ 65 years) who received CPR after 2 days of hospitalization. Main Measures: The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors. Key Results: Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22–0.55) for age ≥ 90 years compared to age 65–69 years, and 0.68 (95% CI, 0.48–0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51–0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40–0.83). Conclusions: Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile.