This is a very interesting paper. I was surprised...

2009-07-13T22:51:03.610-07:00

This is a very interesting paper. I was surprised CPR survival does not seem to have improved since 1992. I dont think the effectiveness of in hospital CPR has improved, but I would have thought that we were better at selecting patients for CPR---specifically avoiding CPR in patients who in whom the chances of survival are nil.

From a research methods point of view, I think the most important caution is that CPR was identified from procedure codes-- ie, whether a hospital noted on the billing claims forms that CPR had occurred. As the authors note, the accuracy of these codes is unknown. It is possible that not all CPR events are coded on the billing forms. It is also possible that CPR may be coded when it does not actually occur. It is fairly common for a "code blue" to be called on a patient who has not had a cardiac arrest, and it is easy to imagine a hospital billing coder recording this as CPR. The authors argue that errors in coding error rates probably have not changed over the years. This may or may not be the case.

With this caveat, I think this study is quite important, and provided important national data on the use and survival of CPR in older persons. But I agree with Eric that the more important questions relate to the long term functioning of patients after discharge. Eric's interest in functional and cognitive outcomes is supported by the landmark work of Terri Fried which shows that these seem to be the outcomes that drive decision making in older persons. Medicare database studies are not able to examine these outcomes. Medicare data should be able to tell us something about long term survival past hospital discharge, and hopefully the authors will extend their work to include this information at some point.

Comments on GeriPal - Geriatrics and Palliative Care Blog: Survival after in-hospital CPR in the Elderly

This is a very interesting paper. I was surprised...