Age as a factor in do not attempt cardiopulmonary resuscitation decisions: a multicentre blinded simulation-based...

Area of Science:

• Medical Ethics
• Cardiopulmonary Resuscitation
• Geriatric Medicine

Background:

• European Resuscitation Council Guidelines highlight a lack of evidence on age's impact on cardiopulmonary resuscitation (CPR) outcomes.
• Clinical decisions regarding CPR often lack direct evidence, particularly concerning the influence of patient age.

Purpose of the Study:

• To investigate the role of patient age in clinicians' decisions to issue a do not attempt cardiopulmonary resuscitation (DNACPR) order.
• To assess if perceived futility, influenced by age, drives DNACPR decisions.

Main Methods:

• A questionnaire-based trial involving 291 clinicians (physicians, surgeons, anaesthetists) across 12 English hospitals.
• Clinicians were randomized to receive patient case vignettes differing only in age (90 vs. 60 years) to assess DNACPR decisions based on perceived futility.

Main Results:

• Clinicians were significantly more likely to issue a DNACPR order for a 90-year-old patient (67.7%) compared to a 60-year-old patient (7.4%), p < 0.001.
• This age-based disparity in DNACPR decisions was consistent across different medical specialties and experience levels.
• Surgeons were less likely to issue DNACPR for 90-year-olds (46.4%) than other consultants, while anaesthetists were more likely to issue DNACPR for 60-year-olds (17.8%).

Conclusions:

• Advanced age is a significant, independent factor influencing clinicians' decisions to withhold cardiopulmonary resuscitation.
• The study reveals a potential discrepancy between current clinical practice regarding age in DNACPR decisions and the available evidence base.