Resuscitation after cardiac surgery: are we ageist?

To study the effect of age and other risk factors on: (a) the incidence and outcome of cardiopulmonary resuscitation and (b) any decision to institute a 'Do Not Attempt Resuscitation' order following cardiac surgery.

Prospective audit of cardiac arrest calls following 6550 consecutive open-heart surgery cases and retrospective audit of all cardiac surgical deaths not preceded by cardiac arrest calls.

One-hundred-and-seventy-four patients (2.7%) had audited cardiac arrests of whom 70 (40%) survived to discharge. Elderly patients (> or = 70 yr old) had higher incidence of cardiac arrest (3.8% vs. 2%, P < 0.001). Survival to discharge following cardiopulmonary resuscitation was lower in the elderly patients, 33% vs. 48%, the difference approaching statistical significance (P = 0.06). Cardiopulmonary resuscitation was withheld in 46% of elderly vs. 40% of younger deaths (P = 0.40) which represented 3.1% of elderly vs. 1.2% younger patients (P < 0.001). Similar proportions of elderly (62%) and younger (67%) patients had failure of > or = 3 organ systems on institution of the 'Do Not Resuscitate' order (P = 0.70).

'Do Not Resuscitate' orders appeared twice as frequently in elderly patients (> or = 70 yr). However, the proportions of deaths without cardiopulmonary resuscitation and the organ failure scores between age groups were similar suggesting that severity of illness was more important than age in determining resuscitation status.