Many people learn about CPR from television. In fact, a 2015 study found that survival after CPR on TV was shown to be around 70%. And it’s not just Hollywood’s influence — surveys reveal that people often believe real-life survival after CPR is greater than 75%. Those sound like great odds. It’s no wonder so many think that everyone should know CPR, and that anyone who has a cardiac arrest should receive it.
But reality tells a different story. Two bioethicists writing in 2017 observed that “CPR has acquired a reputation and aura of almost mythic proportions,” and that withholding it might seem “equivalent to refusing to extend a rope to someone drowning.” (1)
So, what really predicts whether a patient will survive CPR in the hospital? The red flags that make survival to discharge very unlikely. These include:
– Having sepsis the day before the cardiac arrest
– A serum creatinine level higher than 1.5 mg/dl
– Needing help with activities of daily living such was walking, bathing or feeding are just some examples.
– Being hypotensive (low blood pressure) on admission
– Having metastatic cancer
– Having dementia
Each of these factors signals advanced illness and a body already under extreme stress, making CPR much less likely to succeed.
Now let’s look at the data more closely.
When it comes to patients with cancer, CPR outcomes are far worse than what most people expect. Historically, survival was thought to be less than 2%. A large meta-analysis of 42 studies conducted from 1966 to 2005 found that only 6.7% of cancer patients survived to hospital discharge. Outcomes were better for patients with localized disease, at about 9%, but dropped to just 5.6% in those with metastatic cancer (2)
The setting also makes a difference. Patients on hospital wards had about a 10% survival to discharge, while ICU patients had survival rates closer to 2%. Later studies confirmed that simply having a cancer diagnosis made CPR outcomes worse, with nearly four times higher odds of not surviving compared to patients without cancer.
Dialysis patients face a similar story. About 14% survive to hospital discharge after CPR, but very few live long-term. In one study of 74 dialysis patients who underwent CPR, only two — just 3% — were alive at six months, compared to about 9% of non-dialysis controls.
The American Heart Association recommends that all hospitalized patients have an advance directive and that clinicians hold open, honest conversations about prognosis and the likelihood of survival after CPR. When discussing CPR, physicians can explain that about 15%—roughly 1 in 6 patients—who undergo CPR in the hospital survive to discharge. Survival chances, however, decrease significantly in the presence of severe comorbidities (3).
So,while CPR can sometimes restart the heart, the reality — especially for patients with advanced illnesses like cancer, dementia, or kidney failure — is that survival is rare, and meaningful recovery is even rarer.
References:
1.Rosoff PM, Schneiderman LJ. Irrational Exuberance: Cardiopulmonary Resuscitation as Fetish. Am J Bioeth. 2017 Feb;17(2):26-34. doi: 10.1080/15265161.2016.1265163. PMID: 28112611.
2.Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C; American Heart Association. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association. Circulation. 2024 Feb 20;149(8):e914-e933. doi: 10.1161/CIR.0000000000001196. Epub 2024 Jan 22. PMID: 38250800; PMCID: PMC12108947.
3.Reisfield GM, et al. Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis. Resuscitation. 2006; 71:152-160.