Multiple CPR attempts costlier in terms of dollars & survival

Hospitalized patients who receive cardiopulmonary resuscitation (CPR) multiple times are demographically different from their hospitalized counterparts who receive CPR only once, according to a study published in the January issue of the Journal of Hospital Medicine. They tend to be younger, nonwhite and treated in non-teaching hospitals. Survival is also poorer and hospitalizations tend to be higher.

Hadiza S. Kazaure, MD, of Stanford University in Palo Alto, Calif., and colleagues used data from 2000 to 2009 from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), an inpatient database with information from all payers in the U.S.

They divided adult patients into two groups based on the number of CPR attempts (multiple attempts and one attempt). They compared the two groups on age, sex, race, income, hospital type and other variables. As outcomes, the researchers assessed survival to discharge, discharge status and cost of hospitalization.

Out of 65,308,185 adults hospitalized between 2000 and 2009, 166,519 received CPR. Of the CPR recipients, 96.6 percent had CPR once during their hospitalization and 3.4 percent had CPR multiple times.

When compared with one-time recipients, multiple CPR recipients were more likely to be younger, defined as younger than 65 years (37.3 percent vs. 42.5 percent). They also tended to be nonwhite (34.2 percent vs. 41.4 percent) and treated in non-teaching hospitals (58 percent vs. 64.5 percent).

Their survival was also poorer. Survival to discharge decreased by 40 percent with each CPR effort (23.4 percent, 11.9 percent and 6.7 percent respectively for one, two and three attempts). After adjustment, the researchers found an independent association between multiple CPR attempts and lower survival to discharge (odds ratio 0.41). Multiple CPR attempts were more costly as well. The average daily cost was $4,484.60 compared with $3,581.40 for one CPR attempt.

Kazaure et al argued that their findings underscore the need to communicate the risks and benefits of CPR with patients.

“Overall, our study fills an important knowledge gap in resuscitation practice and outcomes in the United States and highlights the importance of discussing resuscitation options between a patient and his or her family on hospital admission and, if needed, again after the first successful resuscitation attempt,” they wrote.