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Int J Cardiol. 2015 Dec 15;201:616-23. doi: 10.1016/j.ijcard.2015.08.143. Epub 2015 Aug 24.

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

Author information

1
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: matilde.winther-jensen@regionh.dk.
2
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
3
Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
4
Emergency Medical Services, The Capital Region of Denmark, Denmark.
5
Department of Thoracic Anesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.

Abstract

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.

KEYWORDS:

Age; Comorbidity; Ethics; Mortality; Neurological outcome; Outcome

PMID:
26340128
DOI:
10.1016/j.ijcard.2015.08.143
[Indexed for MEDLINE]

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