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Capsule Commentary on Hayashi et al., Predictors associated with survival among elderly inpatients who receive cardiopulmonary resuscitation in Japan: an observational cohort study

  • Akira Kuriyama
Capsule Commentary
  • 56 Downloads

Developed nations are graying. Hospitals in these nations come to accommodate a growing number of elderly patients. The outcomes of elderly inpatients, however, are not always happy; there are unexpected in-hospital deaths.

This cohort study 1 examined survival at hospital discharge among elderly inpatients (aged ≥ 65) who received cardiopulmonary resuscitation (CPR), using an administrative data from 81 Japanese acute hospitals. Hayashi et al. found that 11% of 5365 patients survived to discharge, which is lower than the survival rate of previous studies.2 The authors found that older age, multiple comorbidities (Charlson Comorbidity Index of ≥ 4), cancer, and hematological diseases reduced survival, which is clinically believable.

Institutional-level factors associated with reduced survival included CPR on weekends and small-sized hospitals. A recent US registry study also found that survival rates were lower after CRP during on-hours in comparison with off-hours.3 Hayashi et al. hypothesized that the hospital staffing patterns and the subsequent availability of rapid response systems might be the underlying mechanism of reduced survival after in-hospital CPR. Although not examined in this study, other potential hypotheses for these findings included that large hospitals may afford to hire sufficient staff on off-hours thereby achieving a higher nursing staff ratio, provide better quality of care post CPR, conduct routine CPR simulations as training, or eventually nurture hospital culture and well-organized resuscitation teams.4

This study also provides an opportunity to ponder on the importance of advanced care planning. This is a particularly sensitive topic among Japanese; the majority of Japanese avoid discussing advanced care planning or advanced directives5 because it has long been taboo. In Japan, as in the rest of the world, there is a need for frank conversation between patients and clinicians regarding advanced directives, based on patient age and baseline comorbidities.

Notes

Compliance with Ethical Standards

Conflict of Interest

The author declare that he does not have a conflict of interest.

References

  1. 1.
    Hayashi T, Matsushima M, Bito S, Kanazawa N, Inoue N, Luthe SK, Wee CC. Predictors associated with survival among elderly inpatients who receive cardiopulmonary resuscitation in Japan: an observational cohort study. J Gen Intern Med. (SPI 4747). 2018.Google Scholar
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    van Gijn MS, Frijns D, van de Glind EM, C van Munster B, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing. 2014;43(4):456–63.Google Scholar
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    Ofoma UR, Basnet S, Berger A, Kirchner HL, Girotra S; American Heart Association Get With the Guidelines – Resuscitation Investigators. Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. J Am Coll Cardiol. 2018;71(4):402–411.CrossRefGoogle Scholar
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    Merchant RM, Berg RA, Yang L, Becker LB, Groeneveld PW, Chan PS; American Heart Association's Get With the Guidelines-Resuscitation Investigators. Hospital variation in survival after in-hospital cardiac arrest. J Am Heart Assoc. 2014;3(1):e000400.CrossRefGoogle Scholar
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    Aoki T, Miyashita J, Yamamoto Y, Ikenoue T, Kise M, Fujinuma Y, Fukuma S, Kimachi M, Shimizu S, Fukuhara S. Patient experience of primary care and advance care planning: a multicentre cross-sectional study in Japan. Fam Pract. 2017;34(2):206–212.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  1. 1.Emergency and Critical Care Center Kurashiki Central HospitalOkayamaJapan

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