Journal of General Internal Medicine

, Volume 34, Issue 2, pp 206–210 | Cite as

Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study

  • Tetsuro HayashiEmail author
  • Masato Matsushima
  • Seiji Bito
  • Natsuko Kanazawa
  • Norihiko Inoue
  • Sarah Kyuragi Luthe
  • Christina C. Wee
Original Research



Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan.


To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival.


Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016.


We included elderly patients (age ≥ 65 years) who received CPR after 2 days of hospitalization.

Main Measures

The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors.

Key Results

Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22–0.55) for age ≥ 90 years compared to age 65–69 years, and 0.68 (95% CI, 0.48–0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51–0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40–0.83).


Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile.


aging end-of-life care decision making evidence base medicine 



We thank Mr. Masaya Nakadera for the assistance with data extraction and thank Dr. Suminobu Ito and Dr. Hiromasa Horiguchi for organizing this research.


This study was supported by a research grant for post-graduate students from Jikei University School of Medicine. The study sponsor had no role in the study design, data collection, analysis and interpretation, report writing, or the decision to submit the article for publication. MM is the program director of Jikei Clinical Research Program for Primary Care, and TH was a former trainee of the Jikei Clinical Research Program for Primary Care. When this study was conducted, TH was the Shigeaki Hinohara, MD, International Primary Care Fellow at Beth Israel Deaconess Medical Center (BIDMC) which was supported by the Ryoichi Sasakawa Fellowship Fund at BIDMC. SL was supported by grants from World Bank and Kamiyama Foundation. CW is supported by Midcareer Mentorship Award from the National Institutes of Health (K24DK087932).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4747_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)


  1. 1.
    Miller DL, Jahnigen DW, Gorbien MJ, Simbartl L. Cardiopulmonary resuscitation: how useful? Attitudes and knowledge of an elderly population. Arch Intern Med. 1992;152(3):578–582.CrossRefGoogle Scholar
  2. 2.
    Schonwetter RS, Walker RM, Kramer DR, Robinson BE. Resuscitation decision making in the elderly: the value of outcome data. J Gen Intern Med. 1993;8(6):295–300.CrossRefGoogle Scholar
  3. 3.
    Mead GE, Turnbull CJ. Cardiopulmonary resuscitation in the elderly: patients' and relatives' views. J Med Ethics. 1995;21(1):39–44.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Frank C, Heyland DK, Chen B, Farquhar D, Myers K, Iwaasa K. Determining resuscitation preferences of elderly inpatients: a review of the literature. CMAJ. 2003;169(8):795–799.PubMedCentralGoogle Scholar
  5. 5.
    Miller DL, Gorbien MJ, Simbartl LA, Jahnigen DW. Factors influencing physicians in recommending in-hospital cardiopulmonary resuscitation. Arch Intern Med. 1993;153(17):1999–2003.CrossRefGoogle Scholar
  6. 6.
    Murphy DJ, Burrows D, Santilli S, et al. The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330(8):545–549.CrossRefGoogle Scholar
  7. 7.
    van Gijn MS, Frijns D, van de Glind EM, B CvM, Hamaker ME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing 2014;43(4):456–463.CrossRefGoogle Scholar
  8. 8.
    Galea S, Blaney S, Nandi A, et al. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol 2007;166(5):534–543.CrossRefGoogle Scholar
  9. 9.
    Ehlenbach WJ, Barnato AE, Curtis JR, et al. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009;361(1):22–31.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Tokudome S, Hashimoto S, Igata A. Life expectancy and healthy life expectancy of Japan: the fastest graying society in the world. BMC Res Notes 2016;9(1):482.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Sasaki A, Hiraoka E, Homma Y, et al. Association of code status discussion with invasive procedures among advanced-stage cancer and noncancer patients. Int J Gen Med 2017;10:207–214.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Tanaka S, Seto K, Kawakami K. Pharmacoepidemiology in Japan: medical databases and research achievements. J Pharm Health Care Sci 2015;1:16.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Sumitani M, Uchida K, Yasunaga H, et al. Prevalence of malignant hyperthermia and relationship with anesthetics in Japan: data from the diagnosis procedure combination database. Anesthesiology 2011;114(1):84–90.CrossRefGoogle Scholar
  14. 14.
    Isogai T, Yasunaga H, Matsui H, et al. Effect of weekend admission for acute myocardial infarction on in-hospital mortality: a retrospective cohort study. Int J Cardiol 2015;179:315–320.CrossRefGoogle Scholar
  15. 15.
    Shigematsu K, Nakano H, Watanabe Y. The eye response test alone is sufficient to predict stroke outcome--reintroduction of Japan Coma Scale: a cohort study. BMJ Open. 2013;3(4).Google Scholar
  16. 16.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.CrossRefGoogle Scholar
  17. 17.
    Larkin GL, Copes WS, Nathanson BH, Kaye W. Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation. Resuscitation 2010;81(3):302–311.CrossRefGoogle Scholar
  18. 18.
    Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006;295(1):50–57.CrossRefGoogle Scholar
  19. 19.
    Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58(3):297–308.CrossRefGoogle Scholar
  20. 20.
    Peberdy MA, Ornato JP, Larkin GL, et al. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008;299(7):785–792.CrossRefGoogle Scholar
  21. 21.
    Koike T, Nakagawa M, Shimozawa N, et al. The implementation of rapid response system in Japanese hospitals: its obstacles and possible solutions. J Jap Assoc Acute Med 2017;28(6):219–229 (in Japanese).Google Scholar
  22. 22.
    Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H. Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 2017;27(10):476–482.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Tetsuro Hayashi
    • 1
    • 2
    Email author
  • Masato Matsushima
    • 2
  • Seiji Bito
    • 1
  • Natsuko Kanazawa
    • 3
    • 4
  • Norihiko Inoue
    • 3
    • 4
  • Sarah Kyuragi Luthe
    • 5
  • Christina C. Wee
    • 6
  1. 1.Division of Clinical Epidemiology National Hospital Organization Tokyo Medical CenterTokyoJapan
  2. 2.Division of Clinical EpidemiologyThe Jikei University School of MedicineTokyoJapan
  3. 3.Department of Clinical Data Management and Research, Clinical Research CenterNational Hospital Organization HeadquartersTokyoJapan
  4. 4.Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate SchoolTokyoJapan
  5. 5.Department of Anesthesiology and Critical Care MedicineAsahikawa Medical UniversityAsahikawaJapan
  6. 6.General Medicine and Primary Care, Department of MedicineBeth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations