Cardiopulmonary resuscitation in the Elderly: Beneficial or an exercise in futility?

The aging of the American population is the most important demographic factor affecting the prevalence of cardiac arrhythmias because heart disease increases in prevalence with advancing age. Sudden cardiac death (SCD) is one of the leading causes of death and a major public health problem, representing 30% of all nontraumatic and 50% of all coronary artery disease–related deaths. In the United States approximately 300,000 to 400,000 sudden deaths occur annually, and about two thirds of these victims are above the age of 65 years. 20,21 SCD may be a terminal event after a prolonged debilitating and painful illness, such as cancer, or it may occur following many years of symptoms related to a cardiac disorder. In many elderly persons, however, cardiac arrest may be the first manifestation of cardiac disease, in a supposedly healthy and physically active elderly person. Depending on the clinical situation and the person's beliefs, SCD may be viewed as a blessing or a tragedy. Certainly, the person's age will influence the manner in which SCD is perceived. Whether cardiopulmonary resuscitation (CPR) should be performed in elderly patients who sustain cardiac arrest is a significant issue confronting the medical profession as well as the general public. The issue has both ethical and economic implications. Several questions must be answered to put this matter in the right perspective: 1What is the percentage of elderly patients who will survive CPR, and are elderly survivors (compared with younger survivors) more likely to have significant neurologic impairment? 2Will they be able to live independently functional lives, or will they spend their remaining years in a long-term care institution? 3What is the hospital course in elderly patients who are successfully resuscitated? 4Will the hospital stay be significantly longer in elderly survivors, and will medical costs be extremely expensive in this group of patients, whose long-term survival is problematic? Such questions require answers in a society that is struggling with the ethical issues of providing meaningful life versus prolonging suffering in an environment of medical care cost containment. This article explores the issues raised earlier and attempts to decide if CPR is beneficial in elderly patients compared with younger patients following a cardiac arrest. The authors examine the data regarding the site of the cardiac arrest, including in-hospital, out-of-hospital, and nursing home settings. The functional status of survivors and the duration of hospitalization and stays in intensive care units are assessed, to determine if there are any significant differences in the clinical characteristics between elderly and younger patients who sustain cardiac arrest and determine whether any prearrest or arrest characteristics are predictive of survival. Lastly, a possible difference in the mechanism of the cardiac arrest between the age groups is investigated. The definition of elderly in the literature varies from study to study. In most studies, the elderly are defined as ≥ 70 years or older. We are unaware of any study that specifically examined very elderly patients, although in all studies the elderly groups included some patients 80 years or older, and some studies included patients 100 years or older.