To determine the prevalence of clinician perception of inappropriate cardiopulmonary
resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered
in an adult 80 years or older and its relationship to patient outcome.Subanalysis
of an international multicenter cross-sectional survey (REAPPROPRIATE).Out-of-hospital
CPR attempts registered in Europe, Israel, Japan, and the United States in adults
80 years or older.A total of 611 clinicians of whom 176 (28.8%) were doctors, 123
(20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics.The
last CPR attempt among patients 80 years or older was perceived as appropriate by
320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness,
and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital
discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the
"uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23);
503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing
homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate
by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness;
and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital
discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR
attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were
undertaken despite a known written do not attempt resuscitation decision; 14 of 36
(38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about
its appropriateness, and 13 of 36 (36.1%) considered this inappropriate.Our findings
show that despite generally poor outcomes for older patients undergoing CPR, many
emergency clinicians do not consider these attempts at resuscitation to be inappropriate.
A professional and societal debate is urgently needed to ensure that first we do not
harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
