Resuscitation preferences of the elderly: Implications for the need for regularly repeated end-of-life discussions

Abstract

In concordance with the principles of bioethics, [1] Mentzelopoulos S.D. Slowther A.M. Fritz Z. Sandroni C. Xanthos T. Callaway C. Perkins G.D. Newgard C. Ischaki E. Greif R. Kompanje E. Bossaert L. Ethical challenges in resuscitation. Intensive Care Med. 2018; 44: 703-716 Crossref PubMed Scopus (39) Google Scholar an acute illness-driven visit to the emergency department (ED), with or without subsequent hospital admission, may constitute an appropriate trigger for discussing emergency care plans, including cardiopulmonary resuscitation (CPR). [2] Pitcher D. Fritz Z. Wang M. Spiller J.A. Emergency care and resuscitation plans. BMJ. 2017; 356j876 PubMed Google Scholar CPR is a potentially life-saving, invasive medical procedure, not intended for patients dying from an irreversible condition and not suggested for patients with a very low probability (e.g. <1%) of a favorable outcome. 2 Pitcher D. Fritz Z. Wang M. Spiller J.A. Emergency care and resuscitation plans. BMJ. 2017; 356j876 PubMed Google Scholar , 3 Mentzelopoulos S.D. Couper K. Voorde P.V. Druwé P. Blom M. Perkins G.D. Lulic I. Djakow J. Raffay V. Lilja G. Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation. 2021; 161: 408-432 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 4 George N. Thai T.N. Chan P.S. Ebell M.H. Predicting the probability of survival with mild or moderate neurological dysfunction after in-hospital cardiopulmonary arrest: The GO-FAR 2 score. Resuscitation. 2020; 146: 162-169 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Ideally, the patient’s resuscitation preferences should be based on the best available research evidence on core cardiac arrest outcomes, 5 Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong MEH, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD; COSCA Collaborators. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation. 2018;127:147-163. Google Scholar , 6 Djärv T. Bremer A. Herlitz J. Israelsson J. Cronberg T. Lilja G. Rawshani A. Årestedt K. Health-related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: A Swedish population-based registry study. Resuscitation. 2020; 151: 77-84 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 7 Nishiyama C, Kiguchi T, Okubo M, Alihodžić H, Al-Araji R, Baldi E, Beganton F, Booth S, Bray J, Christensen E, Cresta R, Finn J, Gräsner JT, Jouven X, Kern KB, Maconochie I, Masterson S, McNally B, Nolan JP, Eng Hock Ong M, Perkins GD, Ho Park J, Ristau P, Savastano S, Shahidah N, Do Shin S, Soar J, Tjelmeland I, Quinn M, Wnent J, Wyckoff MH, Iwami T. Three-year trends in out-of-hospital cardiac arrest across the world: Second report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2023;186:109757. Google Scholar , 8 Israelsson J. Koistinen L. Årestedt K. Rooth M. Bremer A. Associations between comorbidity and health-related quality of life among in-hospital cardiac arrest survivors - A cross-sectional nationwide registry study. Resuscitation. 2023; 188109822 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar and their pertinent values and goals. [3] Mentzelopoulos S.D. Couper K. Voorde P.V. Druwé P. Blom M. Perkins G.D. Lulic I. Djakow J. Raffay V. Lilja G. Bossaert L. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation. 2021; 161: 408-432 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar However, in the ED setting, expressed preferences and relevant decisions may be affected by acutely ensuing factors, such as illness-related physical/emotional stress (including potential fear of imminent death) or clouding of consciousness, time constraints due to the urgency of diagnostic/therapeutic interventions, as well as the absence of any previously established patient-physician trust/partnership for shared decision-making. 9 Kon AA, Davidson JE, Morrison W, Danis M, White DB; American College of Critical Care Medicine; American Thoracic Society. Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement. Crit Care Med. 2016;44:188-201. Google Scholar , 10 Hall C.C. Lugton J. Spiller J.A. Carduff E. CPR decision-making conversations in the UK: an integrative review. BMJ Support Palliat Care. 2019; 9: 1-11 Crossref PubMed Scopus (20) Google Scholar