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


OBJECTIVE
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.


CONCLUSIONS
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.
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark. Electronic address: matilde.winther-jensen@regionh.dk.
Matilde
M
Winther-Jensen
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Jesper
J
Kjaergaard
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Christian
C
Hassager
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
John
J
Bro-Jeppesen
Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
Niklas
N
Nielsen
Emergency Medical Services, The Capital Region of Denmark, Denmark.
Freddy K
FK
Lippert
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Lars
L
Køber
Department of Thoracic Anesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Michael
M
Wanscher
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Helle
H
Søholm
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Age; Comorbidity; Ethics; Mortality; Neurological outcome; Outcome