Quantitative and qualitative aspects of cardiopulmonary resuscitation in aged in-patients

Abstract

A written 'do not resuscitate' (DNR) order is given after judging cardiopulmonary resuscitation (CPR) as medically futile in either quantitative (effectiveness of CPR) or qualitative (quality of life before and after CPR) terms. Eighteen resuscitation studies have been reviewed, with special attention being paid to the definitions of CPR, the pre-arrest morbidity, the localization of the CPR in a hospital and the effectiveness of CPR. The effectiveness of CPR (as discharge rate from the hospital) of elderly in-patients is only below 5% in exceptional conditions. This suggests that there are no quantitative reasons for withholding CPR from an elderly patient simply because of age. The qualitative aspects of CPR seem to be more important, but more studies are needed to clarify the practice of present-day DNR policy. The qualitative aspects of CPR need ethical consideration, and two main viewpoints are discussed: favouring the physician's authority and favouring the patient's authority. Because of a lack of thorough research, practical advice remains difficult.