title: Short- and long-term outcome in elderly patients after out-of-hospital cardiac arrest: a cohort study.
abstract: OBJECTIVE
  Determinants of outcome and long-term survival are unknown in elderly patients successfully resuscitated after out-of-hospital cardiac arrest. Our aim was to identify factors associated with short- and long-term neurologic outcome in such patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary hospital in Paris, France.
  
  
  METHODS
  Patients aged over 75 admitted in our ICU after an out-of-hospital cardiac arrest between 2000 and 2009.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two hundred twenty-five patients were included in the study. Fifty-seven patients (25.3%) had a good neurologic outcome at ICU discharge (Cerebral Performance Category 1-2). By multivariate logistic regression analysis, factors associated with good short-term outcome were time from collapse to cardiopulmonary resuscitation less than or equal to 3 minutes (odds ratio = 4.06; 95% CI, 1.49-11.09, p = 0.006) and blood lactate level less than or equal to 5.1 mmol/L (odds ratio = 3.30; 95% CI, 1.05-10.39, p = 0.04), but age less than or equal to 79.5 years and use of induced hypothermia were not. Long-term survivors were assessed for cognitive and functional status (using Cerebral Performance Category and Overall Performance Category scales), and their survival was compared with a large community-based cohort of participants over 75 years. The 1-year survival of ICU survivors (mean follow-up, 28.4 mo) was 69.3% (95% CI, 55.8-79.5) as compared with 95.3% (95% CI, 93.3-97.3) in the control community-based cohort (p< 0.001), resulting in a standardized mortality ratio of 3.49 (95% CI, 2.42-4.85). By multivariate Cox proportional hazard model, factors associated with long-term survival were initial shockable rhythm (hazard ratio = 1.41; 95% CI, 1.01-1.96; p = 0.04), epinephrine cumulate dose less than or equal to 3 mg (hazard ratio = 1.48; 95% CI, 1.06-2.08; p = 0.02), and blood lactate level less than or equal to 5.1 mmol/L (hazard ratio = 2.11; 95% CI, 1.5-2.96; p < 0.001). When available at end of follow-up, 91% and 74% of the patients were classified Cerebral Performance Category 1 and Overall Performance Category 1, respectively.
  
  
  CONCLUSIONS
  Neurologic outcome in successfully resuscitated elderly patients depends on cardiac arrest characteristics rather than age. Short-term survival is 25% with acceptable long-term outcome among survivors.
authors: 1Medical Intensive Care Unit, Cochin University Hospital, Hopitaux Universitaires Paris Centre, AP-HP, Paris, France.. 2Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France. 3INSERM U970, Paris Cardiovascular Research Center, Paris, France. 4Emergency Department, Cochin University Hospital, Hopitaux Universitaires Paris Centre, AP-HP, Paris, France. 5Cardiology Department, Cochin University Hospital, Hopitaux Universitaires Paris Centre, AP-HP, Paris, France. 6SAMU 75, Necker University Hospital, AP-HP, Paris, France.
authors: David
authors: D
authors: Grimaldi
authors: Florence
authors: F
authors: Dumas
authors: Marie-Cécile
authors: MC
authors: Perier
authors: Julien
authors: J
authors: Charpentier
authors: Olivier
authors: O
authors: Varenne
authors: Benjamin
authors: B
authors: Zuber
authors: Benoit
authors: B
authors: Vivien
authors: Frédéric
authors: F
authors: Pène
authors: Jean-Paul
authors: JP
authors: Mira
authors: Jean-Philippe
authors: JP
authors: Empana
authors: Alain
authors: A
authors: Cariou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D017741:Survivors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome