Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest

TY - JOUR

T1 - Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest

AU - Winther-Jensen, Matilde

AU - Pellis, Tommaso

AU - Kuiper, Michael

AU - Koopmans, Matty

AU - Hassager, Christian

AU - Nielsen, Niklas

AU - Wetterslev, Jørn

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Friberg, Hans

AU - Gasche, Yvan

AU - Horn, Janneke

AU - Hovdenes, Jan

AU - Stammet, Pascal

AU - Wanscher, Michael

AU - Wise, Matthew P

AU - Åneman, Anders

AU - Kjaergaard, Jesper

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Aim: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. Methods and results: 950 patients included in the target temperature management (TTM) trial were randomly allocated to TTM at 33 or 36. °C for 24. h. We assessed survival and cerebral outcome (cerebral performance category, CPC and modified Rankin scale, mRS) using age as predictor, dividing patients into 5 age groups: ≤65 (median), 66-70, 71-75, 76-80 and >80 years of age. Shockable rhythm decreased with higher age groups, p=. 0.001, the same was true for ST segment elevation on ECG at admission, p<. 0.01. Increasing age was associated with a higher mortality rate (HR. =. 1.04 per year, 95% CI. =. 1.03-1.06, p<. 0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR. =. 3.5, CI: 2.5-5.0, p<. 0.001) compared to patients ≤65 years of age. Favorable vs. unfavorable outcome measured by CPC and mRS in survivors was different between age groups with adverse outcomes more prevalent in higher age groups (CPC: p=. 0.04, mRS: p=. 0.001). The interaction between age and target temperature allocation was not statistically significant for either mortality or neurological outcome. Conclusion: Increasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age, but is not modified by level of target temperature.

AB - Aim: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. Methods and results: 950 patients included in the target temperature management (TTM) trial were randomly allocated to TTM at 33 or 36. °C for 24. h. We assessed survival and cerebral outcome (cerebral performance category, CPC and modified Rankin scale, mRS) using age as predictor, dividing patients into 5 age groups: ≤65 (median), 66-70, 71-75, 76-80 and >80 years of age. Shockable rhythm decreased with higher age groups, p=. 0.001, the same was true for ST segment elevation on ECG at admission, p<. 0.01. Increasing age was associated with a higher mortality rate (HR. =. 1.04 per year, 95% CI. =. 1.03-1.06, p<. 0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR. =. 3.5, CI: 2.5-5.0, p<. 0.001) compared to patients ≤65 years of age. Favorable vs. unfavorable outcome measured by CPC and mRS in survivors was different between age groups with adverse outcomes more prevalent in higher age groups (CPC: p=. 0.04, mRS: p=. 0.001). The interaction between age and target temperature allocation was not statistically significant for either mortality or neurological outcome. Conclusion: Increasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age, but is not modified by level of target temperature.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Humans

KW - Hypothermia, Induced

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest

KW - Prognosis

KW - Regression Analysis

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1016/j.resuscitation.2014.12.030

DO - 10.1016/j.resuscitation.2014.12.030

M3 - Journal article

C2 - 25597506

SN - 0300-9572

VL - 91

SP - 92

EP - 98

JO - Resuscitation

JF - Resuscitation

ER -