• A P Schneider, D J Nelson, and D D Brown.
• St. Joseph Hospital, Lexington, KY.
• J Am Board Fam Pract. 1993 Mar 1;6(2):91-101.

BackgroundWe performed a meta-analysis to: (1) assess the disputed issue of in-hospital cardiopulmonary resuscitation (CPR) success rates among elderly patients, (2) investigate the possibility of a declining CPR success rate between 1960 and 1990, (3) provide an overview estimate of CPR effectiveness in specific patient groups, and (4) assess CPR risks.MethodsNinety-eight reports providing in-hospital CPR survival-to-discharge rates were included in this overview. These reports were identified from MEDLINE searches, previous reviews, and reference citations.ResultsA pooled analysis revealed that 2994 (15 percent) of 19,955 patients were successfully resuscitated (survival to discharge). The rate of successful CPR has not changed in 30 years (r = -0.14, P > 0.05), but there has been a steady decline in the optimism regarding its value (r = -0.29, P < 0.01). Patients younger than 70 years of age had a success rate of 16.2 percent (odds ratio = 1.36; 95 percent confidence interval, 1.20 to 1.53) versus 12.4 percent for patients older than 70 years (P < 0.001). Community hospitals had a higher CPR success rate than teaching hospitals (18.5 percent versus 13.6 percent, P < 0.001). Although 72.9 percent of the post-CPR deaths were within 72 hours, prolonged in hospital survival in a vegetative state did occur; 1.6 percent of successfully resuscitated patients had a permanent neurological impairment.ConclusionThe increasing pessimism about the value of CPR, specifically, its futility in the elderly patient, is not supported by this review. The results of this meta-analysis should assist both the physician and the patient in determining the probable outcome of CPR.

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