Fig. 2.
Expanded approach to decision-making regarding cardiopulmonary resuscitation (CPR) in older surgical patients. In patients age 75 yr or greater, anesthesiologists should be attuned to documentation or evidence of conditions that indicate vulnerability to complications after cardiopulmonary resuscitation, including age 85 yr or greater, American Society of Anesthesiologists (ASA) Physical Status IV or greater, frailty, and functional impairment. Whenever possible, the presence of these conditions should trigger discussion with patients (or their surrogates in cases of decisional incapacity) to clarify preferences regarding perioperative resuscitation. Further evidence will enable refinement of the criteria that should be used to define “high-risk” in this context. The goal-directed approach outlined in figure 1 and in American Society of Anesthesiologists guidelines is preserved.