Cardiopulmonary Resuscitation in Patients With Terminal Illness: An Evidence-Based Analysis.
BACKGROUND
Cardiopulmonary resuscitation (CPR) was first introduced in 1960 for people who unexpectedly experience sudden cardiac arrest. Over the years, it became routine practice in all institutions to perform CPR for all patients even though, for some patients with fatal conditions, application of CPR only prolongs the dying process through temporarily restoring cardiac function.


OBJECTIVE
This analysis aims to systematically review the literature to provide an accurate estimate of survival following CPR in patients with terminal health conditions.


METHODS
A literature search was performed for studies published from January 1, 2004, until January 10, 2014. The search was updated monthly to March 1, 2014.


METHODS
Abstracts and full text of studies that met eligibility criteria were reviewed. Reference lists were also examined for any additional relevant studies not identified through the search.


RESULTS
Cancer patients have lower survival rates following CPR than patients with conditions other than cancer, and cancer patients who receive CPR in intensive care units have one-fifth the rate of survival to discharge of cancer patients who receive CPR in general wards. While the meta-analysis of studies published between 1967 and 2005 reported a lower survival to discharge for cancer patients (6.2%), more recent studies reported higher survival to discharge or to 30-day survival for these patients. Higher survival rates in more recent studies could originate with more "do not attempt resuscitation" orders for patients with end-stage cancer in recent years. Older age does not significantly decrease the rate of survival following CPR while the degree, the type, and the number of chronic health conditions; functional dependence; and multiple CPRs (particularly in advanced age) do reduce survival rates. Emergency Medical Services response time have a significant impact on survival following out-of-hospital CPR.


CONCLUSIONS
Survival after CPR depends on the severity of illness, type and number of health conditions, functional dependence, and multiple CPRs.
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Sehatzadeh
D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D019317:Evidence-Based Medicine; D006801:Humans; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods