title: Multiple Cardiopulmonary Resuscitation Attempts in a Community Hospital: Evaluation of the Futility Assessment.
abstract: BACKGROUND
  In hospital settings, inadequate recognition of futility of aggressive medical management in patients with terminal disease and lack of the timely transition to palliative care may lead to both excessive and potentially harmful treatment and unnecessary burden on hospital resources. In order to better understand the outcomes of futile medical management and recognize the need for more appropriate end-of-life care, we evaluated the survival of particularly vulnerable cohort of patients in a community hospital who had survived at least 1 cardiorespiratory arrest (CRA) but whose medical problems led to subsequent arrests.
  
  
  METHODS
  In this retrospective cohort study, we have reviewed the annual cardiopulmonary resuscitation (CPR) data in a community hospital in urban settings.
  
  
  RESULTS
  Analyzing the population of all patients who had CRA, 22.4% had more than 1 CRA episode and had multiple CPRs (42% of all inpatient CPR were performed on this group of patients). Overall survival at the discharge of patients who had single CRA is significantly better than survival at the discharge of patients who had more than 1 CRA episode (31% vs 4.5%). Only 18.5% of the patients who initially survived CPR after CRA were transitioned to "do not resuscitate" status subsequently, while vast majority had continued aggressive resuscitative efforts.
  
  
  CONCLUSIONS
  Adjusting medical care based on futility assessment in patients with chronic illness who survive CRA is often neglected, but crucially relevant step in the optimization of health care system management.
authors.affiliation: Cabrini Medical Center, Mount Sinai School of Medicine, New York, NY, USA Division of Pulmonary and Critical Care, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA ibarjaktarevic@mednet.ucla.edu.
authors.forename: Igor
authors.initials: I
authors.lastname: Barjaktarevic
authors.affiliation: Cabrini Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Lohaliz
authors.initials: L
authors.lastname: Bobe
authors.affiliation: Cabrini Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Klapholz
authors.affiliation: Cabrini Medical Center, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Dinan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D014505:Urban Population
keywords: cardiopulmonary resuscitation; cardiorespiratory (cardiac) arrest; futility; resuscitation