Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older

Stefanie G Beesems; Marieke T Blom; Martine H A van der Pas; Michiel Hulleman; Esther M M van de Glind; Barbara C van Munster; Jan G P Tijssen; Hanno L Tan; Johannes J M van Delden; Rudolph W Koster

doi:10.1016/j.resuscitation.2015.06.017

Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older

Resuscitation. 2015 Sep:94:33-9. doi: 10.1016/j.resuscitation.2015.06.017. Epub 2015 Jun 25.

Affiliations

¹ Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. Electronic address: s.g.beesems@amc.nl.
² Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
³ Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
⁴ Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
⁵ Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands; Department of Geriatrics, Gelre Hospitals, Postbus 9014, 7300 DS Apeldoorn, The Netherlands.

PMID: 26116780
DOI: 10.1016/j.resuscitation.2015.06.017

Abstract

Introduction: Advanced age is reported to be associated with lower survival after out-of-hospital cardiac arrest (OHCA). We aimed to establish survival rate and neurological outcome at hospital discharge after OHCA in older patients and evaluated whether pre-OHCA comorbidity was associated with favorable neurologic outcome.

Methods: From a prospective registry of all cardiopulmonary resuscitation (CPR) attempts after OHCA, we established survival in 1332 patients aged ≥ 70 years in whom resuscitation with non-traumatic etiology was attempted in 2009-2011. Pre-OHCA factors (age, gender, residing in long-term care institution, Charlson Comorbidity Index [CCI] score) and resuscitation parameters (initial rhythm, bystander witnessed, bystander CPR and time to defibrillator connection) with survival at hospital discharge with favorable neurologic outcome were regressed in the 851 patients of whom CCI was known.

Results: We found a 12% survival to discharge rate in patients aged ≥ 70 years (70-79 years: 16%; ≥ 80 years: 8%, p=0.001). Among surviving patients, 90% survived with favorable neurologic outcome. In a model with only pre-OHCA factors age was significantly associated with outcome (age OR 0.94, 95%CI 0.91-0.98), p = 0.003). High CCI score (≥ 4) was not statistically significant when associated with survival (7% vs. 12%, OR 0.53, 95%CI (0.25-1.13), p = 0.10). When adjusted for resuscitation parameters, OR for high CCI was 0.71 (95% CI 0.28-1.80, p = 0.47), also none of the other pre-OHCA factors remained statistically significant.

Conclusion: In the Netherlands, the survival rate in older patients was 12%; the great majority survived with favorable neurologic outcome. Resuscitation-related factors and not comorbidity determine outcome after OHCA in older patients.

Keywords: Advance care planning; Aging; Cardiopulmonary resuscitation; Comorbidity; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cardiopulmonary Resuscitation / methods*
Comorbidity
Emergency Medical Services
Female
Follow-Up Studies
Humans
Male
Nervous System Diseases / epidemiology*
Netherlands / epidemiology
Out-of-Hospital Cardiac Arrest / epidemiology*
Out-of-Hospital Cardiac Arrest / therapy
Patient Discharge / trends
Prognosis
Prospective Studies
Registries*
Survival Rate / trends
Time Factors
Treatment Outcome