“While most people believe that CPR works 60-85% of the time, in fact the actual survival to hospital discharge is more like 10-15% for all patients and less than 5% for the elderly and those with serious illnesses.”

Charles F. von Gunten, MD PhD and David E. Weissman, MD presented this summary. Find more at:

End of Life/Palliative Education Resource Center (EPERC)

Summary of the medical literature on resuscitation:

Interpreting the data on in-hospital resuscitation is not easy because some studies include both respiratory and cardiac arrests. Resuscitation rates are always better when respiratory arrests are included (CPR is not needed in a pure respiratory arrest). These studies look at various end-points to evaluate the effectiveness of resuscitation including return of spontaneous circulation (ROSC), 24-hour survival, 3-month survival, and 1-year survival. Most studies emphasize short-term results and few look at 1-year survival. A representative study showed immediate resuscitation rates of 44% with 15% survival to discharge, but only a 5% one year survival. Another study showed 34.5% recovered from arrest, 12% left the hospital, and only 8.5% survived six weeks.

When we exclude respiratory arrest (only including cardiac arrest requiring CPR) and look at patients over age 70, survival to discharge is predominantly less than 10% with a few studies showing higher survival rates.

Survival rates vary widely based on factors that I will discuss below. For example, in one study of resuscitation for cardiac arrest of patients over age 70, there were no survivors to discharge. Another Canadian study found a 1% survival to discharge for patients that suffered an unwitnessed cardiac arrest in the hospital. Therefore we need to know what factors lead to significant success with resuscitation vs. factors that predict a poor outcome.

Factors Impacting Outcomes for In-hospital Cardiac Arrests

Positive Predictors	Negative Predictors
Hospital Setting: - Operating room - Cardiac catheterization lab - Emergency Room - Coronary Care Unit	Hospital Setting - General Medical/ Surgical Unit - Intensive Care Unit
Witnessed arrest	Unwitnessed arrest
Ventricular Fibrillation as initial rhythm	Pneumonia
Respiratory arrest (no CPR)	Older age
Short duration of CPR	Other Medical Conditions
	Initial rhythm: Pulseless electrical activity or asystole
	Previous CPR

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These studies focus on in-hospital resuscitation. Out of hospital resuscitation rates are significantly lower.

The other factor to consider is that about 40% of those resuscitated in one study had a significant neurological injury.

Based on this data, who should consider requesting DNR?

This is a deeply personal decision and one that should be discussed carefully among family members and with one’s personal physician. I recommend that you take this list to your physician and ask him or her to review your condition in view of these predictors. You should also consider these factors when being admitted to a hospital.

If you are admitted with a heart attack or heart rhythm problem, you will have the best chance of surviving resuscitation.

If you decide in favor of DNR, most hospitals have a policy of revoking the DNR during surgery or a cardiac catheterization since resuscitation rates are very high and you would be in a highly monitored environment. Discuss all these issues with your physicians.

From the Appendix of A Death Prolonged

Be sure to read about the misconceptions that both doctors and the general public have about resuscitation.