title: Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan.
abstract: To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over.
  
  
  
  A prospective, population-based, observational study was conducted for ≥80-year-old individuals who experienced out-of-hospital cardiac arrest and to whom resuscitation was provided by emergency responders between January 1, 2005 and December 31, 2012 (n=377,577). The primary endpoint was 1-month survival. Signal detection analysis was applied to estimate predictive factors among 17 variables.
  
  
  
  Among all out-of-hospital cardiac arrest cases, 59.4% were of cardiac origin, and 1-month survival rate was 3.3%. Following signal detection analysis, cases of both cardiac and non-cardiac origin were categorized into three subgroups defined by return of spontaneous circulation (ROSC) and epinephrine use. One-month survival ranged between 1.2 and 41.0% for the three subgroups of cardiac origin and between 2.0 and 41.1% for the three subgroups of non-cardiac origin.
  
  
  
  ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80years old.
authors.affiliation: Kyushu University, Faculty of Medical Sciences, Department of Advanced Medical Initiatives, Fukuoka, Japan. Electronic address: nagata.takashi@kyudai.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Yokohama City University Medical Center, Advanced Critical Care and Emergency Center, Yokohama, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Abe
authors.affiliation: Ministry of Health, Welfare and Labor, Health Service Bureau, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Kyusyu University Graduate School of Medicine, Department of Health Services Management and Policy, Fukuoka, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Hagihara
mesh_terms: D000369:Aged, 80 and over; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016414:Resuscitation Orders; D016019:Survival Analysis; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D002317:Cardiovascular Agents; D004837:Epinephrine
keywords: Epinephrine; Older people; Out of hospital cardiac arrest; Return of spontaneous circulation; Signal detection analysis; Termination of resuscitation