Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

TY - JOUR

T1 - Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

AU - Winther-Jensen, Matilde

AU - Kjaergaard, Jesper

AU - Hassager, Christian

AU - Bro-Jeppesen, John

AU - Nielsen, Niklas

AU - Lippert, Freddy K

AU - Køber, Lars

AU - Wanscher, Michael

AU - Søholm, Helle

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

PY - 2015/10/10

Y1 - 2015/10/10

N2 - Background Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. Objectives We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥ 80) to assess whether resuscitation and post resuscitation care should be avoided. Methods During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). Results 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n = 558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients < 80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR = 1.61 CI: 1.22-2.13, p < 0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p < 0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p < 0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n = 26) of octogenarians compared to 86% (n = 317, p = 0.03) in the younger patients. Conclusion OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified.

AB - Background Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. Objectives We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥ 80) to assess whether resuscitation and post resuscitation care should be avoided. Methods During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). Results 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n = 558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients < 80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR = 1.61 CI: 1.22-2.13, p < 0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p < 0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p < 0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n = 26) of octogenarians compared to 86% (n = 317, p = 0.03) in the younger patients. Conclusion OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified.

U2 - 10.1016/j.ijcard.2015.08.143

DO - 10.1016/j.ijcard.2015.08.143

M3 - Journal article

C2 - 26340128

SN - 0167-5273

VL - 201

SP - 616

EP - 623

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -