Changing the Paradigm of In-Hospital Cardiopulmonary Resuscitation

University of Vermont

Status: Completed

Conditions: Advanced Malignancy; Oxygen Dependent COPD

Treatments: Behavioral: Informational Brochure; Behavioral: Informed Assent

Study type: Interventional

Funder types: Other

Identifiers

NCT01558817

PilotCPR001

Details and patient eligibility

About

Outcomes after in-hospital cardiopulmonary resuscitation (CPR) are very poor, particularly in patients with oxygen dependent chronic obstructive pulmonary disease (COPD) or metastatic cancer. Recent work found that in-hospital CPR is being performed more often before death with unchanging survival and that fewer CPR survivors are being discharged home, thus suggesting that CPR is increasingly performed without benefit and that the burden of this ineffective treatment is increasing. Unlike other medical procedures, CPR has become the default provided to all patients even those with tremendously poor outcomes. It is time to change the paradigm of CPR. Through comparing an innovative "informed assent" approach toward in-hospital CPR (informing patients that their underlying chronic illness makes outcomes of CPR so poor that CPR is not performed while allowing them to disagree) versus usual care in a group of chronically ill patients with reduced life expectancy, the investigators aspire to demonstrate that CPR delivery can be reduced. And in addition that DNR status increases, while preserving patient quality of life and decreasing the burden of this ineffective treatment to both patients and families. If effective, this informed assent intervention has the potential to revolutionize how the investigators discuss CPR with the investigators chronically ill patients.

Enrollment: 29 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years or older
• Oxygen dependent COPD or Advanced Malignancy
• Life expectancy of less than two years

Exclusion criteria

• Subjects who have already firmly decided to undergo CPR
• Subjects enrolled in a hospice program
• Subjects unable to speak English
• Subjects incapable of making their own decisions at the time of enrollment
• Subjects cared for by the study investigator

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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29 participants in 2 patient groups

Informational brochure

Active Comparator group

Description:

Patients receive an informational brochure

Treatment:

Behavioral: Informational Brochure

Intervention

Experimental group

Description:

Patients receive physician-directed informed assent intervention regarding CPR and informational brochure.

Treatment:

Behavioral: Informed Assent