Societal opinions regarding CPR

• Published in: The American journal of emergency medicine 2002-05, Vol.20 (3), p.207-211
• Main Authors: Marco, Catherine A., Schears, Raquel M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Advance Directives; Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Attitude to Health; Biological and medical sciences; cardiac arrest; Cardiopulmonary Resuscitation - statistics & numerical data; Cross-Sectional Studies; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; futility; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Intensive care medicine; Male; Medical Futility; Medical sciences; Middle Aged; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public Opinion; Resuscitation; United States - epidemiology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1053/ajem.2002.32626

Resuscitative measures are traditionally undertaken for most patients with cardiac arrest, unless an advance directive exists. This long-standing default presumption of patients' wishes to undergo resuscitation has never been proven. This study was undertaken to determine societal preferences of the general public regarding resuscitation. A cross-sectional survey was administered at community events to 724 volunteer participants over a 16-month period. For 6 hypothetical clinical scenarios (previously piloted and validated), respondents indicated personal preferences regarding resuscitation attempts for themselves. Most respondents indicated preferences for resuscitative efforts in a scenario depicting a young, healthy patient (96%), whereas few would desire resuscitative efforts for an elderly, debilitated patient (27%) (P < .01, Fisher's exact test). Nearly all (98%) respondents showed a trend (by scalogram analysis) toward refusal of resuscitative efforts in scenarios depicting more elderly, debilitated patients. Respondents had inaccurate perceptions of survival rates after cardiac arrest; the mean estimated survival rate was 50% (range 0%-100%). Although the majority of respondents had a personal physician (82%), only 10% of respondents had ever discussed death or resuscitation with their physicians. This study shows a trend in personal opinion among the general public toward refusal of resuscitative efforts in clinical scenarios with poor prognoses. Because so few patients have completed advance directives, physician awareness of such public opinions may be useful in decision-making in end-of-life care, particularly when caring for patients without advance directives. These public opinions support the feasibility of establishing societal consensus regarding resuscitation preferences, which may be useful in the development of federal and local guidelines and policies. (Am J Emerg Med 2002;20:207-211. Copyright 2002, Elsevier Science (USA). All rights reserved.)