Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-11T01:01:49.675Z Has data issue: false hasContentIssue false
  • English
  • Français

Resuscitation after cardiac surgery: are we ageist?

Published online by Cambridge University Press:  23 December 2004

J. H. Mackay ,
S. J. Powell ,
S. C. Charman  and
C. Rozario
J. H. Mackay
Affiliation:
Papworth Hospital, Cambridge, UK
S. J. Powell
Affiliation:
Papworth Hospital, Cambridge, UK
S. C. Charman
Affiliation:
MRC Biostatistics Unit, Cambridge, UK
C. Rozario
Affiliation:
Papworth Hospital, Cambridge, UK
Get access

Extract

Summary

Background and objective: To study the effect of age and other risk factors on: (a) the incidence and outcome of cardiopulmonary resuscitation and (b) any decision to institute a ‘Do Not Attempt Resuscitation’ order following cardiac surgery.

Methods: Prospective audit of cardiac arrest calls following 6550 consecutive open-heart surgery cases and retrospective audit of all cardiac surgical deaths not preceded by cardiac arrest calls.

Results: One-hundred-and-seventy-four patients (2.7%) had audited cardiac arrests of whom 70 (40%) survived to discharge. Elderly patients (≥70 yr old) had higher incidence of cardiac arrest (3.8% vs. 2%, P < 0.001). Survival to discharge following cardiopulmonary resuscitation was lower in the elderly patients, 33% vs. 48%, the difference approaching statistical significance (P = 0.06). Cardiopulmonary resuscitation was withheld in 46% of elderly vs. 40% of younger deaths (P = 0.40) which represented 3.1% of elderly vs. 1.2% younger patients (P < 0.001). Similar proportions of elderly (62%) and younger (67%) patients had failure of ≥3 organ systems on institution of the ‘Do Not Resuscitate’ order (P = 0.70).

Conclusion: ‘Do Not Resuscitate’ orders appeared twice as frequently in elderly patients (≥70 yr). However, the proportions of deaths without cardiopulmonary resuscitation and the organ failure scores between age groups were similar suggesting that severity of illness was more important than age in determining resuscitation status.

Keywords

EMERGENCY TREATMENT, resuscitation, cardiopulmonary resuscitationEPIDEMIOLOGICAL FACTORS, age factorsEPIDEMIOLOGIC FACTORS, causality, risk factorsHAEMORRHAGE, postoperative haemorrhageMULTIPLE ORGAN FAILURESPECIALTIES, SURGICAL, thoracic surgeryPROGNOSIS, treatment outcome
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 1 , January 2004 , pp. 66 - 71
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gwinnutt CL, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation 2000; 47: 125–135.Google Scholar
De Vos R, Koster RW, de Haan RJ, Oosting H, van der Wouw PA, Lampe-Schenmaeckers AJ. In-hospital cardiopulmonary resuscitation: pre arrest morbidity and outcome. Arch Intern Med 1999; 159: 845–850.Google Scholar
Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989; 79 (Suppl I): 3–12.Google Scholar
Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R and the EuroSCORE study group. European system for cardiac operative risk evaluation. Eur J Cardiothorac Surg 1999; 15: 816–823.Google Scholar
Kollef MH, Wragge T, Pasque C. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged ventilation. Chest 1995; 107: 1395–1401.Google Scholar
Decisions relating to cardiopulmonary resuscitation. A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. (February 2001) http://www.resus.org.uk/pages/dnar.htm
el-Banayosy A, Brehm C, Kizner L, et al. Cardiopulmonary resuscitation after cardiac surgery: a two-year study. J Cardiothorac Vasc Anesth 1998; 12: 390–392.Google Scholar
Wahba A, Gotz W, Birnbaum DE. Outcome of cardiopulmonary resuscitation following heart surgery. Scand Cardiovasc J 1997; 31: 147–149.Google Scholar
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in acute organ failure. Ann Surg 1985; 202: 685–692.Google Scholar
Cummins RO, Chamberlain D, Hazinski MF, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style.’ A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Resuscitation 1997; 34: 151–183.Google Scholar
Mackay JH, Powell SJ, Osgathorp J, Rozario CJ. Six-year prospective audit of chest reopening after cardiac arrest. Eur J Cardiothorac Surg 2002; 22: 421–425.Google Scholar
Ebrahim S. Do not resuscitate decisions: flogging dead horses or a dignified death? BMJ 2000; 320: 1155–1156.Google Scholar
Boseley S. Milburn steps into resuscitation row. The Guardian 2000; September 6.Google Scholar