title: Prehospital predictors of neurological outcomes in out-of-hospital cardiac arrest patients aged 95 years and older: A nationwide population-based observational study.
abstract: Population aging has rapidly progressed in Japan. However, few data exist regarding the characteristics of extremely elderly patients with out-of-hospital cardiac arrest (OHCA). We aimed to determine the prehospital predictors of one-month survival with favorable neurological outcomes (Cerebral Performance Category scale, category 1 or 2; CPC 1-2) in this population.
  
  
  
  We investigated 23,520 OHCA patients aged ≥95 years from a prospectively recorded, nationwide, Utstein-style Japanese database between 2008 and 2012. The primary study endpoint was one-month CPC 1-2 after OHCA.
  
  
  
  The one-month CPC 1-2 rate was 0.27% (63/23,520). Only two variables were significantly associated with one-month CPC 1-2 in a multivariate logistic regression model: prehospital return of spontaneous circulation (ROSC) [adjusted odds ratio (aOR), 94.4; 95% confidential interval (CI), 50.1-191.7] and emergency medical service (EMS)-witnessed arrest (aOR, 5.1; 95% CI, 2.6-10.2). When stratified by these two predictors, the one-month CPC 1-2 rates were 20.2% (18/89) for patients who had both prehospital ROSC and EMS-witnessed arrest, 4.2% (33/783) for those who had prehospital ROSC without EMS-witnessed arrest, 0.28% (3/1065) for those who had EMS-witnessed arrest without prehospital ROSC, and 0.04% (9/21,583) for those who had neither predictor, respectively.
  
  
  
  The crucial prehospital predictors for one-month CPC 1-2 in elderly OHCA patients aged ≥95 years in Japan were prehospital ROSC and EMS-witnessed arrest and the former was the predominant predictor.
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Funada
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan. Electronic address: gotoyosh@med.kanazawa-u.ac.jp.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Tada
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Teramoto
authors.affiliation: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan; Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
mesh_terms: D000369:Aged, 80 and over; D003326:Coronary Circulation / Q000502:physiology*; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiopulmonary resuscitation; Elderly; Epidemiology; Medical futility; Out-of-hospital cardiac arrest