1
|
Miedel C, Jonsson M, Dragas M, Djärv T, Nordberg P, Rawshani A, Claesson A, Forsberg S, Nord A, Herlitz J, Riva G. Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis. Europace 2024; 26:euae126. [PMID: 38743799 PMCID: PMC11110941 DOI: 10.1093/europace/euae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 05/16/2024] Open
Abstract
AIMS Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors. METHODS AND RESULTS This was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010-2020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women and men, and a mediation analysis was performed to investigate the importance of potential mediators. Total of 43 226 OHCAs were included, of which 14 249 (33.0%) were women. Women were older and had a lower proportion of shockable initial rhythm. The crude 30-day survival among women was 6.2% compared to 10.7% for men [RR 0.58, 95% confidence interval (CI) = 0.54-0.62]. Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI = 0.79-0.91). Further adjustments for age and resuscitation factors attenuated the survival difference to null (RR 0.98; 95% CI = 0.92-1.05). Mediation analysis showed that shockable initial rhythm explained ∼50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables, respectively. CONCLUSION Women have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.
Collapse
Affiliation(s)
- Charlotte Miedel
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Martin Jonsson
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Mariana Dragas
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Therese Djärv
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Andreas Claesson
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Anette Nord
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Johan Herlitz
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden
| | - Gabriel Riva
- Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| |
Collapse
|
2
|
Ong CA, Nadarajan GD, Fook-Chong S, Shahidah N, Arulanandam S, Ng YY, Chia MYC, Tiah L, Mao DR, Ng WM, Leong BSH, Doctor N, Ong MEH, Siddiqui FJ. Increasing neurologically intact survival after out-of-hospital cardiac arrest among elderly: Singapore Experience. Resusc Plus 2024; 17:100573. [PMID: 38370311 PMCID: PMC10869923 DOI: 10.1016/j.resplu.2024.100573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives With more elderly presenting with Out-of-Hospital Cardiac Arrests (OHCAs) globally, neurologically intact survival (NIS) should be the aim of resuscitation. We aimed to study the trend of OHCA amongst elderly in a large Asian registry to identify if age is independently associated with NIS and factors associated with NIS. Methods All adult OHCAs aged ≥18 years attended by emergency medical services (EMS) from April 2010 to December 2019 in Singapore was extracted from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. Cases pronounced dead at scene, non-EMS transported, traumatic OHCAs and OHCAs in ambulances were excluded. Patient characteristics and outcomes were compared across four age categories (18-64, 65-79, 80-89, ≥90). Multivariable logistic regression analysis determined the factors associated with NIS. Results 19,519 eligible cases were analyzed. OHCA incidence increased with age almost doubling in octogenarians (from 312/100,000 in 2011 to 652/100,000 in 2019) and tripling in those ≥90 years (from 458/100,000 in 2011 to 1271/100,000 in 2019). The proportion of patients with NIS improved over time for the 18-64, 65-79- and 80-89-years age groups, with the greatest improvement in the youngest group. NIS decreased with each increasing year of age and minute of response time. NIS increased in the arrests of presumed cardiac etiology, witnessed and bystander CPR. Conclusions Survival with good outcomes has increased even amongst the elderly. Regardless of age, NIS is possible with good-quality CPR, highlighting its importance. End-of-life planning is a complex yet necessary decision that requires qualitative exploration with elderly, their families and care providers.
Collapse
Affiliation(s)
- Chloe Alexis Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
| | | | | | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
| | - Shalini Arulanandam
- Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore
| | - Yih Yng Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University of Singapore, Singapore
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | - Desmond R Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Nausheen Doctor
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Fahad J Siddiqui
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
| |
Collapse
|
3
|
Chahine J, Kosmopoulos M, Raveendran G, Yannopoulos D, Bartos JA. Impact of age on survival for patients receiving ECPR for refractory out-of-hospital VT/VF cardiac arrest. Resuscitation 2023; 193:109998. [PMID: 37832628 DOI: 10.1016/j.resuscitation.2023.109998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve neurologically favorable survival for patients with refractory ventricular tachycardia (VT)/ventricular fibrillation (VF) out-of-hospital cardiac arrest. Prior studies of the impact of age on outcomes in ECPR have demonstrated mixed results and we aim to investigate this relationship. METHODS Patients treated with ECPR at the University of Minnesota Medical Center for refractory out-of-hospital VT/VF arrest from December 2015 to February 2023 were included. The primary endpoints included neurologically favorable survival to discharge. A receiver operating characteristic curve was used to determine an optimal predictive age limit with the highest accuracy for neurologically favorable survival. RESULTS 391 consecutive patients were included: 22% (n = 86) were female and the mean age was 56.9 ± 11.8 years. Age was independently associated with neurologically favorable survival to discharge, with a 30% decrease in survival with every 10-year increase in age (OR 0.7 (0.57-0.87), p = 0.001. Among those with neurologically favorable survival to discharge, older patients had longer length of hospital stay compared to younger age groups (p = 0.002) while patients who failed to achieve neurologically favorable survival to discharge had similar length of stay independent of age (p = 0.51). CONCLUSIONS Age is associated with neurologically favorable survival to discharge for patients receiving ECPR for refractory out-of-the-hospital VT/VF cardiac arrest. However, with a survival rate of 23% in the oldest age group, caution should be used when choosing age criteria for patient selection.
Collapse
Affiliation(s)
- Johnny Chahine
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Ganesh Raveendran
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States. https://twitter.com/@jason_bartos
| |
Collapse
|
4
|
Nanna MG, Sutton NR, Kochar A, Rymer JA, Lowenstern AM, Gackenbach G, Hummel SL, Goyal P, Rich MW, Kirkpatrick JN, Krishnaswami A, Alexander KP, Forman DE, Bortnick AE, Batchelor W, Damluji AA. Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel. JACC. ADVANCES 2023; 2:100389. [PMID: 37584013 PMCID: PMC10426754 DOI: 10.1016/j.jacadv.2023.100389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
As the population ages, older adults represent an increasing proportion of patients referred to the cardiac catheterization laboratory. Older adults are the highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating patients who are likely to derive net benefit vs those who have disproportionate risks for harm. Conventional risk assessment tools from national cardiovascular societies typically rely on 3 pillars: 1) cardiovascular risk; 2) physiologic and hemodynamic risk; and 3) anatomic and procedural risks. We propose adding a fourth pillar: geriatric syndromes, as geriatric domains can supersede all other aspects of risk.
Collapse
Affiliation(s)
| | - Nadia R. Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, and Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Ajar Kochar
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Grace Gackenbach
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Scott L. Hummel
- University of Michigan School of Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael W. Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James N. Kirkpatrick
- Division of Cardiology, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
| | | | - Daniel E. Forman
- Divisions of Geriatrics and Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh GRECC, Pittsburgh, Pennsylvania, USA
| | - Anna E. Bortnick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Elon RD. Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care? J Am Med Dir Assoc 2023:S1525-8610(23)00107-X. [PMID: 36868267 DOI: 10.1016/j.jamda.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
Although the use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings over the past 20+ years, the adoption of AEDs in US nursing facilities is variable and the current number of facilities with AEDs is unknown. Recent research into the use of AEDs as part of cardiopulmonary resuscitation (CPR) procedures for nursing facility residents with sudden cardiac arrest demonstrates improved outcomes in the limited cohort with witnessed arrests, early bystander CPR, and an initial amenable rhythm, shocked with an AED before the arrival of Emergency Medical Services (EMS) personnel. This article reviews data about outcomes of CPR in older adults and nursing facility settings and proposes that standard procedures for CPR attempts in US nursing facilities should be reevaluated and continue to evolve, commensurate with the evidence and community standards.
Collapse
Affiliation(s)
- Rebecca D Elon
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
6
|
Bruno RR, Wernly B, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, Jung C. Management and outcomes in critically ill nonagenarian versus octogenarian patients. BMC Geriatr 2021; 21:576. [PMID: 34666709 PMCID: PMC8524896 DOI: 10.1186/s12877-021-02476-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration NCT03134807 and NCT03370692.
Collapse
Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.,Cardiovascular Research Institute Düsseldorf (CARID), Duesseldorf, Germany
| | - Ariane Boumendil
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.,Geriatric Research Group, Brescia, Italy
| | - Finn H Andersen
- Department Of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,NTNU, Dep of Circulation and Medical Imaging, Trondheim, Norway
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBERes Corporacion Sanitaria Universitaria Parc Tauli, Barcelona, Spain
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, BG, Italy
| | - Maurizio Cecconi
- Department of Anaesthesia, IRCCS Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Johanna M Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Faculdade de Ciências Médicas de Lisboa, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Nova Médical School, Lisbon, Portugal
| | - Sandra Oeyen
- Department of Intensive Care, 1K12IC Ghent University Hospital, Ghent, Belgium
| | | | | | - Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | | | | | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | - Carole Boulanger
- NAHP Committee ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Sten Walther
- Linkoping University Hospital, Linkoping, Sweden
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Service de Réanimation Médicale, Publique-Hôpital de Paris, Hôpital Saint-Antoine, F-75012, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | | |
Collapse
|
7
|
Miyamoto Y, Matsuyama T, Goto T, Ohbe H, Kitamura T, Yasunaga H, Ohta B. Association between age and neurological outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: a nationwide multicentre observational study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 11:35-42. [PMID: 33880567 DOI: 10.1093/ehjacc/zuab021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/14/2022]
Abstract
AIMS Little is known about the difference in outcomes between young and old patients who received extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Therefore, we aimed to investigate the differences in outcomes between those aged ≥75 years and <75 years who experienced OHCA and were resuscitated with ECPR. METHODS AND RESULTS We performed a secondary analysis of a nationwide prospective cohort study using the Japanese Association for Acute Medicine OHCA registry. We identified patients aged ≥18 years with OHCA who received ECPR. The patients were classified into three age groups (18-59 years, 60-74 years, and ≥75 years). The primary outcome was a 1-month neurological outcome. To examine the association between age and 1-month neurological outcome, we performed logistic regression analyses fitted with generalized estimating equations. From 2014 to 2017, we identified 875 OHCA patients aged ≥18 years who received ECPR. The proportion of patients who survived with favourable neurological outcome in the patients aged 18-59 years, 60-74 years, and ≥75 years were 15% (64/434), 8.9% (29/326), and 1.7% (2/115), respectively. In the multivariable analysis, compared with the age of 18-59 years, the proportions of favourable neurological outcomes were significantly lower in patients aged 60-74 years [adjusted odds ratio (OR), 0.44; 95% confidence interval (CI), 0.32-0.61] and those aged ≥75 years (adjusted OR, 0.26; 95% CI, 0.11-0.59). CONCLUSION Advanced age (age ≥75 years in particular) was significantly associated with poor neurological outcomes in patients with OHCA who received ECPR.
Collapse
Affiliation(s)
- Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 1130033, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 1130033, Japan.,TXP Medical Co. Ltd., Hongo 7-3-1, Bunkyo-ku, Tokyo 1138485, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 1130033, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 5650871, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 1130033, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto 6028566, Japan
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW To describe the epidemiology, prognostication, and treatment of out- and in-hospital cardiac arrest (OHCA and IHCA) in elderly patients. RECENT FINDINGS Elderly patients undergoing cardiac arrest (CA) challenge the appropriateness of attempting cardiopulmonary resuscitation (CPR). Current literature suggests that factors traditionally associated with survival to hospital discharge and neurologically intact survival after CA cardiac arrest in general (e.g. presenting ryhthm, bystander CPR, targeted temperature management) may not be similarly favorable in elderly patients. Alternative factors meaningful for outcome in this special population include prearrest functional status, comorbidity load, the specific age subset within the elderly population, and CA location (i.e., nursing versus private home). Age should therefore not be a standalone criterion for withholding CPR. Attempts to perform CPR in an elderly patient should instead stem from a shared decision-making process. SUMMARY An appropriate CPR attempt is an attempt resulting in neurologically intact survival. Appropriate CPR in elderly patients requires better risk classification. Future research should therefore focus on the associations of specific within-elderly age subgroups, comorbidities, and functional status with neurologically intact survival. Reporting must be standardized to enable such evaluation.
Collapse
Affiliation(s)
- Sharon Einav
- anesthesiologist and intensivist, Director of Surgical Intensive Care, Shaare Zedek Medical Center and Associate Professor at the Hebrew University-Hadassah Faculty of Medicine, Ein-Kerem, Jerusalem, Israel
| | - Andrea Cortegiani
- anesthesiologist, Researcher at the Department of Surgical Oncological and Oral Science (Di.Chir.On.S.), University of Palermo; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Esther-Lee Marcus
- geriatrician, head of Chronic Ventilator Dependent Division, Herzog Medical Center, and Clinical Senior Lecturer at the Hebrew University-Hadassah Faculty of Medicine, Ein-Kerem, Jerusalem, Israel
| |
Collapse
|
9
|
Cardiac arrest and related mortality in emergency departments in the United States: Analysis of the nationwide emergency department sample. Resuscitation 2020; 157:166-173. [DOI: 10.1016/j.resuscitation.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/19/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
|
10
|
Geriatric issues in patients with or being considered for implanted cardiac rhythm devices: a case-based review. J Geriatr Cardiol 2020; 17:710-722. [PMID: 33343650 PMCID: PMC7729179 DOI: 10.11909/j.issn.1671-5411.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
11
|
Winther-Jensen M, Christiansen MN, Hassager C, Køber L, Torp-Pedersen C, Hansen SM, Lippert F, Christensen EF, Kjaergaard J, Andersson C. Age-specific trends in incidence and survival of out-of-hospital cardiac arrest from presumed cardiac cause in Denmark 2002-2014. Resuscitation 2020; 152:77-85. [PMID: 32417269 DOI: 10.1016/j.resuscitation.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The general cardiovascular health has improved throughout the last few decades for middle-aged and older individuals, but the incidence of several cardiovascular diseases is reported to increase in younger people. We aimed to assess the age-specific incidence and mortality rates associated with out-of-hospital-cardiac-arrest (OHCA) between 2002 and 2014. METHODS We used the Danish Cardiac Arrest Register to identify patients with OHCA of presumed cardiac etiology. We calculated the annual incidence rates (IR) and 30-day mortality rates (MR) in 7 age groups (18-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years and ≥85 years, and ≤50 vs. >50 years). RESULTS Between 2002 and 2014, IR of OHCA decreased in individuals aged 65-74 and 75-84 years (158.08 to 111.2 and 237.5 to 217.09 per 100,000 person-years) and increased in the oldest from 201.01 to 325.4 pr. 100.000 person-years. In 18-34-years incidence of OHCA increased from 1.7 to 2.6 per 100.000 person-years. When stratifying into age ≤50 vs. >50 years, the IR deviated in those >50 years (from 117.8 in 2002 to 91 in 2008 to 117.4 in 2014100,000 person-years). The prevalence of acute myocardial infarction and heart failure prior to OHCA increased in the younger patient group in contrast to the older segment (AMI: ≤50 years: 10% to 16%, vs. >50 years: 25% to 23%, heart failure: ≤50 years 6% to 14%, vs. >50 years: 21% to 24%). CONCLUSION Over the last decades, incidence rates of OHCA decreased in individuals aged 65-84, but increased in individuals older than 85. An increase was also observed in younger individuals, potentially indicating a need for better cardiovascular disease prevention in younger adults.
Collapse
Affiliation(s)
- Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Epidemiology, Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Mia Nielsen Christiansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, Aalborg 9000, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Erika Frischknecht Christensen
- Center for Prehospital and Emergency Research, Department of Clinical Medicine Aalborg University, Clinic for Internal and Emergency Medicine Aalborg University Hospital, and EMS North Denmark Region, Aalborg, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Charlotte Andersson
- Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Medicine, Section of Cardiovascular Medicine Boston Medical Center, Boston University Boston, MA, USA
| |
Collapse
|
12
|
The CAHP (cardiac arrest hospital prognosis) score: A tool for risk stratification after out-of-hospital cardiac arrest in elderly patients. Resuscitation 2020; 148:200-206. [DOI: 10.1016/j.resuscitation.2020.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 01/23/2023]
|
13
|
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:61. [PMID: 32087741 PMCID: PMC7036236 DOI: 10.1186/s13054-020-2773-2] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
Background To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR). Methods We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis. Results A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI 6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR. Conclusions The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries. Electronic supplementary material The online version of this article (10.1186/s13054-020-2773-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nan Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rixing Wang
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yunqiang Chen
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Zhiqian Luo
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Qiao Zong
- School of International Education, Hainan Medical University, Haikou, Hainan, China
| | - Song Chen
- Department of Emergency, the First Affiliated Hospital of Hainan Medical University, No.3 Xueyuan Road, Longhua Zone, Haikou, 571199, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China. .,Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China. .,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China.
| |
Collapse
|
14
|
Starks MA, Alexander K. In Anticipation of the Inevitable: Preparing Older Americans for Cardiac Arrest. J Am Geriatr Soc 2019; 68:9-10. [PMID: 31840229 DOI: 10.1111/jgs.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Monique Anderson Starks
- Preparing Older Americans for OHCA, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Karen Alexander
- Preparing Older Americans for OHCA, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
15
|
Pätz T, Stelzig K, Pfeifer R, Pittl U, Thiele H, Busch HJ, Reinhard I, Wolfrum S. Age-associated outcomes after survived out-of-hospital cardiac arrest and subsequent target temperature management. Acta Anaesthesiol Scand 2019; 63:1079-1088. [PMID: 31206587 DOI: 10.1111/aas.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/21/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The registry of the German Society of Intensive Care and Emergency Medicine was founded to analyze outcome of modern post-resuscitation care. METHODS A total of 902 patients were analyzed in this retrospective, multicenter, and population-based observational trial on individuals suffering from out-of-hospital cardiac arrest. All patients had return of spontaneous circulation (ROSC) and received TTM after admitted to an intensive care unit. Outcome was focused on age and analyzed by creating 4 subgroups (<65, 65-74, 75-84, ≥85 years). Twenty-eight day and 180-day survival and a favorable neurological outcome according to the Cerebral Performance Category scale were evaluated as clinical endpoints. RESULTS At 28-day and 180-day follow-up, 44.8% and 53.4% of all patients had died, respectively. The evaluation of survival rate by age category revealed a higher mortality, but not an unfavorable neurological prognosis with increasing age. In multiple stepwise regressions, age, time to ROSC, bystander resuscitation, and cardiac cause of cardiac arrest were associated with increased chance of 180-day survival and, in addition, bystander resuscitation, time of hypoxia, and a defibrillation performed by emergency medical service were associated with a favorable neurological outcome at 180-day follow-up. CONCLUSION Increasing age was associated with a higher mortality, but not with an unfavorable neurological outcome. The majority of survivors had a favorable neurologic outcome 6 months after cardiac arrest.
Collapse
Affiliation(s)
- Toni Pätz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care MedicineLübeck Germany
| | - Katharina Stelzig
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
| | - Rüdiger Pfeifer
- Clinic for Internal Medicine University of Jena Jena Germany
| | - Undine Pittl
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig – University Hospital Leipzig Germany
| | - Hans-Jörg Busch
- University Emergency Center University of Freiburg Freiburg Germany
| | - Iris Reinhard
- Department of Biostatistics Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University Mannheim Germany
| | - Sebastian Wolfrum
- Emergency Department University Hospital of Schleswig‐Holstein Lübeck Germany
| |
Collapse
|
16
|
Curtis AB, Karki R, Hattoum A, Sharma UC. Arrhythmias in Patients ≥80 Years of Age: Pathophysiology, Management, and Outcomes. J Am Coll Cardiol 2019; 71:2041-2057. [PMID: 29724357 DOI: 10.1016/j.jacc.2018.03.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/14/2022]
Abstract
Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.
Collapse
Affiliation(s)
- Anne B Curtis
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Roshan Karki
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Alexander Hattoum
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Umesh C Sharma
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
| |
Collapse
|
17
|
Adt C, Salignon J, Freund Y, Espinasse E, Ray P, Avondo A. Influence de l’âge sur les durées de réanimation des arrêts cardiaques préhospitaliers. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : L’objectif de notre étude est de déterminer si l’âge des patients en arrêt cardiaque (AC) a une influence sur les durées de réanimation cardiopulmonaire (RCP) par les équipes préhospitalières.
Patients et méthodes : Nous avons réalisé une étude monocentrique, prospective, à partir des données de notre centre hospitalier universitaire, issues du Registre électronique des arrêts cardiaques. Ont été inclus tous les patients ayant présenté un AC, hormis ceux retrouvés en état de rigidité cadavérique ou qui avaient préalablement exprimé des directives anticipées sur leur fin de vie. Les patients ont été séparés en deux groupes selon leur âge : les moins de 75 ans et ceux de 75 ans et plus. Le critère de jugement principal était la durée de RCP spécialisée décidée par le médecin de l’équipe préhospitalière.
Résultats : Du 1er janvier au 31 décembre 2015, sur 253 patients victimes d’AC, 188 (74 % d’hommes, 78 % d’asystolie) ont bénéficié d’une RCP par une équipe du Service mobile d’urgence et de réanimation. Il y a eu 39 % de récupération d’une activité cardiaque spontanée (RACS). Seuls 31 % des patients étaient admis vivants à l’hôpital, ils étaient 6 % à j30. La durée de RCP était plus importante pour les patients de moins de 75 ans (29 ± 15 vs 23 ± 19 minutes ; p < 0,01). Mais pour les patients ayant une RACS, la durée de RCP était identique entre les deux groupes (16 ± 10 vs 14 ± 9 minutes ; p = 0,34). La survie des patients de 75 ans et plus était de 10 vs 22 % pour les moins de 75 ans (p = 0,35).
Conclusion : Notre étude suggère que l’âge des patients influence négativement les durées de réanimation des équipes préhospitalières.
Collapse
|
18
|
Roedl K, Jarczak D, Becker S, Fuhrmann V, Kluge S, Müller J. Long-term neurological outcomes in patients aged over 90 years who are admitted to the intensive care unit following cardiac arrest. Resuscitation 2018; 132:6-12. [DOI: 10.1016/j.resuscitation.2018.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
|
19
|
Kangasniemi H, Setälä P, Huhtala H, Kämäräinen A, Virkkunen I, Jämsen E, Yli-Hankala A, Hoppu S. Out-of-hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland. Acta Anaesthesiol Scand 2018; 62:1297-1303. [PMID: 29845604 DOI: 10.1111/aas.13152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dispatching Emergency Medical Services to treat patients with deteriorating health in nursing homes and primary care facilities is common in Finland. We examined the cardiac arrest patients to describe this phenomenon. We had a special interest in patients for whom cardiopulmonary resuscitation was considered futile. METHODS We conducted an observational study between 1 June 2013 and 31 May 2014 in the Pirkanmaa area. We included cases in which Emergency Medical Services participated in the treatment of cardiac arrest patients in nursing homes and primary care facilities. RESULTS Emergency Medical Services attended to a total of 355 cardiac arrest patients, and 65 patients (18%) met the inclusion criteria. The included patients were generally older than 65 years, but otherwise heterogeneous. Nineteen patients (29%) had a valid do-not-attempt-resuscitation order, but paramedics were not informed about it in 10 (53%) of those cases. Eight (12%) of the 65 patients survived to hospital admission and 3 (5%) survived to hospital discharge with a neurologically favourable outcome. Two patients were alive 90 days after the cardiac arrest; both were younger than 70 years of age and had ventricular fibrillation as primary rhythm. There were no survivors in nursing homes. CONCLUSIONS The do-not-attempt-resuscitation orders were often unavailable during a cardiopulmonary resuscitation attempt. Although resuscitation attempts were futile for patients in nursing homes, some patients in primary care facilities demonstrated a favourable outcome after cardiac arrest. Emergency Medical Services seem to be able to recognise potential survivors and focus resources on their treatment.
Collapse
Affiliation(s)
- H. Kangasniemi
- Research and Development Unit; FinnHEMS Ltd; WTC Helsinki Airport; Vantaa Finland
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - P. Setälä
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - H. Huhtala
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - A. Kämäräinen
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - I. Virkkunen
- Research and Development Unit; FinnHEMS Ltd; WTC Helsinki Airport; Vantaa Finland
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| | - E. Jämsen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - A. Yli-Hankala
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Anaesthesia; Tampere University Hospital; Tampere Finland
| | - S. Hoppu
- Emergency Medical Services; Tampere University Hospital; Tampere Finland
| |
Collapse
|
20
|
Goto T, Morita S, Kitamura T, Natsukawa T, Sawano H, Hayashi Y, Kai T. Impact of extracorporeal cardiopulmonary resuscitation on outcomes of elderly patients who had out-of-hospital cardiac arrests: a single-centre retrospective analysis. BMJ Open 2018; 8:e019811. [PMID: 29978808 PMCID: PMC5961566 DOI: 10.1136/bmjopen-2017-019811] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Little is known about the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for elderly patients who had out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the impact of age on outcomes among patients who had OHCA treated with ECPR. DESIGN Single-centre retrospective cohort study. SETTING A critical care centre that covers a population of approximately 1 million residents. PARTICIPANTS Patients who had consecutive OHCA aged ≥18 years who underwent ECPR from 2005 to 2013. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were 1 month neurologically favourable outcomes and survival. To determine the association between advanced age and each outcome, we fitted multivariable logistic regression models using: (1) age as a continuous variable and (2) age as a categorical variable (<50 years, 50-59 years, 60-69 years and ≥70 years). RESULTS Overall, 144 patients who had OHCA who underwent ECPR were eligible for our analyses. The proportion of neurologically favourable outcomes was 7%, while survival was 19% in patients who had OHCA. After the adjustment for potential confounders, while advanced age was non-significantly associated with neurologically favourable outcomes (adjusted OR 0.96 (95% CI 0.91 to 1.01), p=0.08), the association between advanced age and the poor survival rate was significant (adjusted OR 0.96 (95% CI 0.93 to 0.99), p=0.04). Additionally, compared with age <50 years, age ≥70 years was non-significantly associated with poor neurological outcomes (adjusted OR 0.08 (95% CI 0.01 to 1.00), p=0.051), whereas age ≥70 years was significantly associated with worse survival in the adjusted model (adjusted OR 0.14 (95% CI 0.03 to 0.80), p=0.03). CONCLUSIONS In our analysis of consecutive OHCA data from a critical care hospital in an urban area of Japan, we found that advanced age was associated with the lower rate of 1-month survival in patients who had OHCA who underwent ECPR. Although larger studies are required to confirm these results, our findings suggest that ECPR may not be beneficial for patients who had OHCA aged ≥70 years.
Collapse
Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Sachiko Morita
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaska, Japan
| | - Tomoaki Natsukawa
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Tatsuro Kai
- Senri Critical Care Medical Centre, Osaka Saiseikai Senri Hospital, Osaka, Japan
| |
Collapse
|
21
|
Segal N, di Pompéo C, Escutnaire J, Wiel E, Dumont C, Castra L, Tazarourte K, El Khoury C, Gueugniaud PY, Hubert H. Evolution of Survival in Cardiac Arrest with Age in Elderly Patients: Is Resuscitation a Dead End? J Emerg Med 2017; 54:295-301. [PMID: 29273461 DOI: 10.1016/j.jemermed.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Even if age is not considered the key prognostic factor for survival in cardiac arrest (CA), some studies question whether cardiopulmonary resuscitation (CPR) in the elderly could be futile. OBJECTIVE The aim of this study was to describe differences in out-of-hospital CA survival rates according to age stratification based on the French National CA registry (RéAC). The second objective was to analyze the differences in resuscitation interventions according to age. METHODS We performed a retrospective cohort study based on data extracted from the RéAC. All 18,249 elderly patients (>65 years old) with non-traumatic CA recorded between July 2011 and March 2015 were included. Patients' ages were stratified into 5-year increments. RESULTS Cardiopulmonary resuscitation (CPR) was started significantly more often in younger patients (p = 0.019). Ventilation and automated external defibrillation by bystanders were started without any difference between age subgroups (p = 0.147 and p = 0.123, respectively). No difference in terms of rate of external chest compressions or ventilation initiation was found between the subgroups (p = 0.357 and p = 0.131, respectively). Advanced cardiac life support was started significantly more often in younger patients (p = 0.023). Total CPR duration, return of spontaneous circulation, and survival at hospital admission and at 30 days or hospital discharge decreased significantly with age (p < 10-3). The survival decrease was linear, with a loss of 3% survival chances each 5-year interval. CONCLUSIONS This study found that survival in older persons decreased linearly by 3% every 5 years. However, this diminished rate of survival could be the consequence of a shorter duration and less advanced life support.
Collapse
Affiliation(s)
- Nicolas Segal
- Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, Paris, France
| | - Christophe di Pompéo
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Joséphine Escutnaire
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Eric Wiel
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France; SAMU 59 and Emergency Department, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Cyrielle Dumont
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Laurent Castra
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | - Karim Tazarourte
- SAMU 69, Lyon University Hospital, University of Claude Bernard-Lyon 1, Edouard Herriot Hospital, Lyon, France
| | - Carlos El Khoury
- Réseau Cardiologie Médecine d'Urgence Network, Hussel Hospital, Vienne, France
| | - Pierre-Yves Gueugniaud
- SAMU 69, Lyon University Hospital, University of Claude Bernard-Lyon 1, Edouard Herriot Hospital, Lyon, France
| | - Hervé Hubert
- Public Health Department EA 2694, University of Lille, Lille University Hospital, 6, Lille Cedex, France
| | -
- Research Group on the French National Out-of-Hospital Cardiac Arrest Registry, RéAC, Lille, France
| |
Collapse
|
22
|
Wiel E, Di Pompéo C, Segal N, Luc G, Marc JB, Vanderstraeten C, El Khoury C, Escutnaire J, Tazarourte K, Gueugniaud PY, Hubert H. Age discrimination in out-of-hospital cardiac arrest care: a case-control study. Eur J Cardiovasc Nurs 2017; 17:505-512. [PMID: 29206063 DOI: 10.1177/1474515117746329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care. AIMS The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients. METHODS We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration. RESULTS We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77-0.92, p<0.001), transport to hospital (OR=0.58, 95% CI 0.51-0.61, p<0.001), vital status at hospital admission (OR=0.55, 95% CI 0.50-0.60, p<0.001) and vital status 30 days after CA (OR=0.42, 95% CI 0.35-0.50, p<0.001). CONCLUSION All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.
Collapse
Affiliation(s)
- Eric Wiel
- 1 Public Health Department, University of Lille, France.,2 SAMU 59 and Emergency Department, Lille University Hospital, France
| | | | - Nicolas Segal
- 3 Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, France
| | - Gérald Luc
- 1 Public Health Department, University of Lille, France
| | | | | | - Carlos El Khoury
- 5 RESCUE (Réseau Cardiologie Médecine d'Urgence) Network, Hussel Hospital, France
| | | | - Karim Tazarourte
- 6 SAMU 69 and Emergency Department, Lyon University Hospital, France
| | | | - Hervé Hubert
- 1 Public Health Department, University of Lille, France
| | -
- 7 Research Group on the French National out-of-hospital cardiac arrest registry, RéAC, France
| |
Collapse
|
23
|
Sulzgruber P, Sterz F, Poppe M, Schober A, Lobmeyr E, Datler P, Keferböck M, Zeiner S, Nürnberger A, Hubner P, Stratil P, Wallmueller C, Weiser C, Warenits AM, van Tulder R, Zajicek A, Buchinger A, Testori C. Age-specific prognostication after out-of-hospital cardiac arrest – The ethical dilemma between ‘life-sustaining treatment’ and ‘the right to die’ in the elderly. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:112-120. [DOI: 10.1177/2048872616672076] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Andreas Schober
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Elisabeth Lobmeyr
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Philip Datler
- Department of Anesthesia, Medical University of Vienna, Austria
| | - Markus Keferböck
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Sebastian Zeiner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Peter Stratil
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | - Christoph Weiser
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | | | | | | | | | - Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Austria
| |
Collapse
|
24
|
Tavares V, Carron PN, Yersin B, Taffé P, Burnand B, Pittet V. The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations. Scand J Trauma Resusc Emerg Med 2016; 24:103. [PMID: 27554262 PMCID: PMC4995648 DOI: 10.1186/s13049-016-0294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician’s initiation of out-of-hospital advanced medical interventions varies with the patient’s age. Methods We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient’s age. Results Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 – 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 – 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 – 83, 84 – 88 and ≥ 89 years). Conclusion The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
Collapse
Affiliation(s)
- Vania Tavares
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
25
|
Long-Term Post-Discharge Risks in Older Survivors of Myocardial Infarction With and Without Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2016; 67:1981-90. [DOI: 10.1016/j.jacc.2016.02.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/23/2022]
|
26
|
Mader TJ, Nathanson BH, Coute RA, McNally BF. A Descriptive Analysis of Therapeutic Hypothermia Application Across Adult Age Groups. Ther Hypothermia Temp Manag 2016; 6:140-5. [PMID: 27111243 DOI: 10.1089/ther.2016.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Therapeutic hypothermia (TH) has been recommended for comatose adults recovering from out-of-hospital cardiac arrest (OHCA) for a decade. However, TH has never been evaluated in a randomized control trial in patients aged 75 or older. How the administration of TH varies across age groups experiencing an OHCA is unknown. The objective was to describe the use of TH across predefined age groups with an emphasis on geriatric OHCA survivors using data compiled through Cardiac Arrest Registry to Enhance Survival (CARES). We hypothesized that TH provision would decline in patients aged 75 or older. This was a secondary analysis of prospectively collected and verified registry data. The study was Institutional Review Board exempt. Through December 2013, CARES had 130,852 completed records for consideration. All nontraumatic adult index arrests of presumed cardiac etiology with attempted resuscitation were study eligible. Sustained return of spontaneous circulation with survival to hospital admission was a prerequisite for inclusion. Exclusion criteria were as follows: records before November 2010 when TH became a mandatory reporting field; pre-existing Do Not Resuscitate directive; missing TH status or outcome classification; and OHCA location and timing variables potentially affecting treatment decisions or eligibility. All records in our final sample were categorized (TH or no TH) for descriptive analysis. Our final sample size was 11,533. The percentage of patients <75 who received TH was 58.5% (95% CI: 57.5-59.6) and 46.4% (95% CI: 44.5-48.3) for those 75 or older. There was no difference in the rate of TH across the age groups from <25 to 65-74 (p = 0.205). Treatment rates significantly decreased from age 75-84 to 95+ (p < 0.001). There is a significant decline in the provision of TH at age 75 years within CARES. Further research is needed to determine if age is an independent predictor of TH underutilization in the elderly.
Collapse
Affiliation(s)
- Timothy J Mader
- 1 Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine , Springfield, Massachusetts
| | | | - Ryan A Coute
- 3 Kansas City University of Medicine and Biosciences , Kansas City, Missouri
| | - Bryan F McNally
- 4 Department of Emergency Medicine, Emory University School of Medicine , Atlanta, Georgia
| |
Collapse
|
27
|
Funada A, Goto Y, Maeda T, Teramoto R, Hayashi K, Yamagishi M. Improved Survival With Favorable Neurological Outcome in Elderly Individuals With Out-of-Hospital Cardiac Arrest in Japan - A Nationwide Observational Cohort Study. Circ J 2016; 80:1153-62. [PMID: 27008923 DOI: 10.1253/circj.cj-15-1285] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital cardiac arrest (OHCA). METHODS AND RESULTS OHCA patients (334,730) aged ≥75 years were analyzed using a nationwide, prospective, population-based Japanese OHCA database from 2008 to 2012. The overall 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2) rate was 0.88%. During the study period, the annual 1-month CPC 1-2 rate in whole OHCA significantly improved (0.73% to 0.96%, P for trend <0.001). In particular, outcomes of OHCA patients aged 75 to 84 years and those aged 85 to 94 years significantly improved (0.98% to 1.28%, P for trend=0.01; 0.46% to 0.70%, P for trend <0.001, respectively). However, in OHCA patients aged ≥95 years, the outcomes did not improve. Multivariate logistic regression analysis indicated that younger age, shockable first documented rhythm, witnessed arrest, earlier emergency medical service (EMS) response time, and cardiac etiology were significantly associated with the 1-month CPC 1-2. Under these conditions, elderly OHCA patients who had cardiac etiology, shockable rhythm and had a witnessed arrest had acceptable 1-month CPC1-2 rate; 7.98% in cases where OHCA was witnessed by family, 15.2% by non-family, and 25.6% by EMS. CONCLUSIONS The annual 1-month CPC 1-2 rate after OHCA among elderly patients significantly improved, and the resuscitation of elderly patients in a selected population is not futile. (Circ J 2016; 80: 1153-1162).
Collapse
Affiliation(s)
- Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital
| | | | | | | | | | | |
Collapse
|
28
|
Kitamura T, Kiyohara K, Matsuyama T, Izawa J, Shimamoto T, Hatakeyama T, Fujii T, Nishiyama C, Iwami T. Epidemiology of Out-of-Hospital Cardiac Arrests Among Japanese Centenarians: 2005 to 2013. Am J Cardiol 2016; 117:894-900. [PMID: 26810860 DOI: 10.1016/j.amjcard.2015.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
Although the number of centenarians has been rapidly increasing in industrialized countries, no clinical studies evaluated their characteristics and outcomes from out-of-hospital cardiac arrests (OHCAs). This nationwide, population-based, observation of the whole population of Japan enrolled consecutive OHCA centenarians with resuscitation attempts before emergency medical service arrival from 2005 to 2013. The primary outcome measure was 1-month survival from OHCAs. The multivariate logistic regression model was used to assess factors associated with 1-month survival in this population. Among a total of 4,937 OHCA centenarians before emergency medical service arrival, the numbers of those with OHCAs increased from 70 in 2005 to 136 in 2013 in men and from 227 in 2005 to 587 in 2013 in women. Women accounted for 80.3%. Ventricular fibrillation (VF) as first documented rhythm was 2.5%. The proportions of victims receiving bystander cardiopulmonary resuscitation were 64.2%. The proportion of 1-month survival from OHCAs in centenarians was only 1.1%. In a multivariate analysis, age was not associated with 1-month survival from OHCAs (adjusted odds ratio [OR] for one increment of age 1.01; 95% confidence interval [CI] 0.87 to 1.18). Witness by a bystander (adjusted OR 3.45; 95% CI 1.88 to 6.31) and VF as first documented rhythm (adjusted OR 5.49; 95% CI 2.24 to 13.43) were significant positive predictors for 1-month survival. Cardiac origin was significantly poor in 1-month survival compared with noncardiac origin (adjusted OR 0.37; 95% CI 0.21 to 0.64). In conclusion, survival from OHCAs in centenarians was very poor, but witness by a bystander and VF as first documented rhythm were associated with improved survival.
Collapse
|
29
|
Kudenchuk PJ, Stuart R, Husain S, Fahrenbruch C, Eisenberg M. Treatment and outcome of out-of-hospital cardiac arrest in outpatient health care facilities. Resuscitation 2015; 97:97-102. [PMID: 26476198 DOI: 10.1016/j.resuscitation.2015.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
AIM We evaluated the frequency and effectiveness of basic and advanced life support (ALS) interventions by medical professionals when out-of-hospital cardiac arrest (OHCA) occurred in ambulatory healthcare clinics before emergency medical services (EMS) arrival. METHODS Non-traumatic OHCAs in adults were systematically characterized over a 15 year period by their occurrence in clinics, at home, or in non-medical public locations, and outcomes compared between matched cohorts from each group. RESULTS Among 7784 patients, 6098 OHCA occurred at home, 1612 in non-medical public locations and 74 in clinics. Compared to non-medical public locations, clinic patients with OHCA were older, more often women and more frequently shocked; clinic arrests were more often witnessed, less likely to be of cardiac cause and to occur before EMS arrival. Compared to home, more clinic arrests were witnessed, occurred after EMS arrival, had bystander CPR, shockable rhythms and were defibrillated. When OHCA occurred before EMS arrival, 51 of 56 clinic patients (91%) received CPR, a defibrillator applied to 23 (41%), 17 (30%) were shocked, 4 (7%) intubated, and 7 (13%) received intravenous medications from facility personnel. Of these, only pre-EMS defibrillator use was associated with improved outcome. Among matched patients, OHCA survival was higher in clinics than at home (42% vs 26%, p=0.029), but comparable to other public locations. CONCLUSIONS Survival from OHCA in clinics was comparable to non-medical public locations, and higher than at home. Alongside CPR, use of defibrillators was associated with improved survival and worth prioritizing over other interventions before EMS arrival regardless of OHCA location.
Collapse
Affiliation(s)
- Peter J Kudenchuk
- University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.
| | - Russell Stuart
- University of Virginia Health System, Department of Anesthesiology, Charlottesville, VA 22903, United States
| | - Sofia Husain
- King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
| | - Carol Fahrenbruch
- King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
| | - Mickey Eisenberg
- University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
| |
Collapse
|
30
|
Winther-Jensen M, Kjaergaard J, Hassager C, Bro-Jeppesen J, Nielsen N, Lippert FK, Køber L, Wanscher M, Søholm H. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile. Int J Cardiol 2015; 201:616-23. [PMID: 26340128 DOI: 10.1016/j.ijcard.2015.08.143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
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.
Collapse
Affiliation(s)
- Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Freddy K Lippert
- Emergency Medical Services, The Capital Region of Denmark, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Michael Wanscher
- Department of Thoracic Anesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Helle Søholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| |
Collapse
|
31
|
Wong SPY, Kreuter W, Curtis JR, Hall YN, O'Hare AM. Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis. JAMA Intern Med 2015; 175:1028-35. [PMID: 25915762 PMCID: PMC4451394 DOI: 10.1001/jamainternmed.2015.0406] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis. OBJECTIVE To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis. DESIGN, SETTING, AND PARTICIPANTS This national retrospective cohort study studied 663,734 Medicare beneficiaries 18 years or older from a comprehensive national registry for end-stage renal disease who initiated maintenance dialysis from January 1, 2000, through December 31, 2010. EXPOSURES Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplantation, or end of follow-up on December 31, 2011. MAIN OUTCOMES AND MEASURES Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up. RESULTS The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days (95% CI, 1.3-1.4). A total of 21.9% CPR recipients (95% CI, 21.4%-22.3%) survived to hospital discharge, with a median postdischarge survival of 5.0 months (interquartile range, 0.7-16.8 months). Among patients who died in the hospital, 14.9% (95% CI, 14.8%-15.1%) received CPR during their terminal admission. From 2000 to 2011, there was an increase in the incidence of CPR (1.0 events per 1000 in-hospital days; 95% CI, 0.9-1.1; to 1.6 events per 1000 in-hospital days; 95% CI, 1.6-1.7; P for trend <.001), the proportion of CPR recipients who survived to discharge (15.2%; 95% CI, 11.1%-20.5%; to 28%; 95% CI, 26.7%-29.4%; P for trend <.001), and the proportion of in-hospital deaths preceded by CPR (9.5%; 95% CI, 8.4%-10.8%; to 19.8%; 95% CI, 19.2%-20.4%; P for trend <.001), with no substantial change in duration of postdischarge survival. CONCLUSIONS AND RELEVANCE Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations.
Collapse
Affiliation(s)
- Susan P Y Wong
- Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle
| | - William Kreuter
- Center for Cost and Outcomes Research, University of Washington, Seattle
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle
| | - Yoshio N Hall
- Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle5Veterans Affairs Puget Sound Healthcare System, Seattle
| | - Ann M O'Hare
- Kidney Research Institute, University of Washington, Seattle2Cambia Palliative Care Center of Excellence, University of Washington, Seattle3Department of Medicine, University of Washington, Seattle5Veterans Affairs Puget Sound Healthcare System, Seattle
| |
Collapse
|
32
|
Terman SW, Shields TA, Hume B, Silbergleit R. The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest. Resuscitation 2015; 89:169-76. [DOI: 10.1016/j.resuscitation.2015.01.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/30/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022]
|
33
|
Wissenberg M, Folke F, Hansen CM, Lippert FK, Kragholm K, Risgaard B, Rajan S, Karlsson L, Søndergaard KB, Hansen SM, Mortensen RN, Weeke P, Christensen EF, Nielsen SL, Gislason GH, Køber L, Torp-Pedersen C. Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival. Circulation 2015; 131:1536-45. [PMID: 25747933 DOI: 10.1161/circulationaha.114.013122] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest has increased during the last decade in Denmark. We aimed to study the impact of age on changes in survival and whether it was possible to identify patients with minimal chance of 30-day survival. METHODS AND RESULTS Using data from the nationwide Danish Cardiac Arrest Registry (2001─2011), we identified 21 480 patients ≥18 years old with a presumed cardiac-caused out-of-hospital cardiac arrest for which resuscitation was attempted. Patients were divided into 3 preselected age-groups: working-age patients 18 to 65 years of age (33.7%), early senior patients 66 to 80 years of age (41.5%), and late senior patients >80 years of age (24.8%). Characteristics in working-age patients, early senior patients, and late senior patients were as follows: witnessed arrest in 53.8%, 51.1%, and 52.1%; bystander cardiopulmonary resuscitation in 44.7%, 30.3%, and 23.4%; and prehospital shock from a defibrillator in 54.7%, 45.0%, and 33.8% (all P<0.05). Between 2001 and 2011, return of spontaneous circulation on hospital arrival increased: working-age patients, from 12.1% to 34.6%; early senior patients, from 6.4% to 21.5%; and late senior patients, from 4.0% to 15.0% (all P<0.001). Furthermore, 30-day survival increased: working-age patients, 5.8% to 22.0% (P<0.001); and early senior patients, 2.7% to 8.4% (P<0.001), whereas late senior patients experienced only a minor increase (1.5% to 2.0%; P=0.01). Overall, 3 of 9499 patients achieved 30-day survival if they met 2 criteria: had not achieved return of spontaneous circulation on hospital arrival and had not received a prehospital shock from a defibrillator. CONCLUSIONS All age groups experienced a large temporal increase in survival on hospital arrival, but the increase in 30-day survival was most prominent in the young. With the use of only 2 criteria, it was possible to identify patients with a minimal chance of 30-day survival.
Collapse
Affiliation(s)
- Mads Wissenberg
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.).
| | - Fredrik Folke
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Carolina Malta Hansen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Freddy K Lippert
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Kristian Kragholm
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Bjarke Risgaard
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Shahzleen Rajan
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Lena Karlsson
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Kathrine Bach Søndergaard
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Steen M Hansen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Rikke Normark Mortensen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Peter Weeke
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Erika Frischknecht Christensen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Søren L Nielsen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Gunnar H Gislason
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Lars Køber
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| | - Christian Torp-Pedersen
- From Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.W., F.F., C.M.H., S.R., L.K., K.B.S., P.W., G.H.G.); Prehospital Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark (F.K.L., S.L.N.); Institute of Health, Science and Technology, Aalborg University, Denmark (K.K., S.M.H., R.N.M., C.T.P.); The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (B.R., L.K.); Prehospital Emergency Medical Services: The Central Denmark Region, Denmark (E.F.C.); Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (S.L.N.); and National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.)
| |
Collapse
|
34
|
Trends in survival among elderly patients with out-of-hospital cardiac arrest: a prospective, population-based observation from 1999 to 2011 in Osaka. Resuscitation 2014; 85:1432-8. [PMID: 25110248 DOI: 10.1016/j.resuscitation.2014.07.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/29/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about the improvement in out-of-hospital cardiac arrest (OHCA) survival among elderly patients. The aim of this study was to evaluate the trends in the survival after bystander-witnessed OHCA of cardiac origin in this age group. METHODS This prospective, population-based, observation of the whole population of Osaka, Japan included consecutive OHCA patients aged ≥65 years with emergency responder resuscitation attempts from January 1999 to December 2011. The primary outcome measure was one-month survival with neurologically favorable outcome, and the trends in the outcome from OHCA were evaluated by location. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome. RESULTS During the study period, a total of 10,876 bystander-witnessed OHCA of cardiac origin were eligible for our analyses. In whole arrests, the proportion of one-month survival with neurologically favorable outcome improved from 1.4% in 1999 to 4.8% in 2011 (P for trend <0.001). The proportion of neurologically favorable outcome in homes and public places improved from 0.7% in 1999 to 3.2% in 2011 (P for trend <0.001) and from 4.2% in 1999 to 20.9% in 2011 (P for trend <0.001), respectively, whereas, in nursing homes, the proportion of neurologically favorable outcome did not improve. In a multivariate analysis, bystander-initiated cardiopulmonary resuscitation and emergency response time were significant predictors for neurologically favorable outcome. CONCLUSIONS In this population, survival from OHCA among elderly patients significantly improved during the study period, but the trends differed by the OHCA location.
Collapse
|
35
|
Busch M, Søreide E. Should advanced age be a limiting factor in providing therapeutic hypothermia to cardiac arrest survivors? A single-center observational study. Ther Hypothermia Temp Manag 2014; 1:29-32. [PMID: 24716885 DOI: 10.1089/ther.2010.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As octogenarians represent the fastest growing segment of the elderly population and the incidence of out-of-hospital cardiac arrest (OHCA) increases with age, the outcome benefit of therapeutic hypothermia (TH) in comatose cardiac arrest survivors is of great interest. The first randomized controlled trials of TH excluded all patients older than 75 years and there exists considerable uncertainty whether the positive findings from these studies apply to older patients. This is a retrospective study of all unconscious OHCA survivors from 2002 to 2008 treated with TH in our intensive care unit who fulfilled the Hypothermia After Cardiac Arrest study inclusion criteria (witnessed, shockable OHCA receiving bystander-cardiopulmonary resuscitation (CPR), interval from collapse to ambulance arrival <15 minutes, and return of spontaneous circulation [ROSC] within 60 minutes) but with no upper age limit. Good cerebral outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category 1-2. The median age of the 113 OHCA survivors studied was 62 years (18-89 years), and 77% were men. Median time from collapse to ROSC was 15 minutes (3-50 minutes). Bystander CPR was performed in 76% and immediate postresuscitation coronary angiography in 63%. The overall good outcome rate was 70%. Both lower age and shorter time to ROSC, as well as bystander CPR and the time period after implementation of the ERC 2005 guidelines were associated with good outcome. Still, 54% of all patients aged >75 years achieved good outcome. Although age seems to influence outcome, we found that more than half of comatose OHCA survivors above 75 years showed a favorable outcome. Hence, our data do not support a limitation of postresuscitation TH based on age alone but highlights the need for more clinical trials of TH in the advanced age group.
Collapse
Affiliation(s)
- Michael Busch
- Department of Anesthesiology and Intensive Care Medicine, Stavanger University Hospital , Stavanger, Norway
| | | |
Collapse
|
36
|
Geriatric experience following cardiac arrest at six interventional cardiology centers in the United States 2006-2011: interplay of age, do-not-resuscitate order, and outcomes. Crit Care Med 2014; 42:289-95. [PMID: 24107639 DOI: 10.1097/ccm.0b013e3182a26ec6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES It is not known if aggressive postresuscitation care, including therapeutic hypothermia and percutaneous coronary intervention, benefits cardiac arrest survivors more than 75 years old. We compared treatments and outcomes of patients at six regional percutaneous coronary intervention centers in the United States to determine if aggressive care of elderly patients was warranted. DESIGN Retrospective evaluation of registry data. SETTING Six interventional cardiology centers in the United States. PATIENTS Six hundred and twenty-five unresponsive cardiac arrest survivors aged 18-75 were compared with 129 similar patients aged more than 75. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cardiac arrest survivors aged more than 75 had more comorbidities (3.0 ± 1.6 vs 2.0 ± 1.6, p < 0.001), but were matched to younger patients in initial heart rhythm, witnessed arrests, bystander cardiopulmonary resuscitation, and total ischemic time. Patients aged more than 75 frequently underwent therapeutic hypothermia (97.7%), urgent coronary angiography (44.2%), and urgent percutaneous coronary intervention (24%). They had more sustained hyperglycemia (70.5% vs 59%, p = 0.015), less postcooling fever (25.2% vs 35.2%, p = 0.03), were more likely to have do-not-resuscitate orders (65.9% vs 48.2%, p < 0.001), and undergo withdrawal of life support (61.2% vs 47.5%, p = 0.005). Good functional outcome at 6 months (Cerebral Performance Category 1-2) was seen in 27.9% elderly versus 40.4% younger patients overall (p = 0.01) and in 44% versus 55% (p = 0.13) of patients with an initial shockable rhythm. Of 35 survivors more than 75 years old, 33 (94.8%) were classified as Cerebral Performance Category 1 or 2 at (mean) 6.5-month follow-up. In multivariable logistic regression modeling, age more than 75 was significantly associated with outcome only when the presence of a do-not-resuscitate order was excluded from the model. CONCLUSIONS Elderly patients were more likely to have do-not-resuscitate orders and to undergo withdrawal of life support. Age was independently associated with outcome only when correction for do-not-resuscitate status was excluded, and functional outcomes of elderly survivors were similar to younger patients. Exclusion of patients more than 75 years old from aggressive care is not warranted on the basis of age alone.
Collapse
|
37
|
van de Glind EMM, van Munster BC, van de Wetering FT, van Delden JJM, Scholten RJPM, Hooft L. Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review. BMC Geriatr 2013; 13:68. [PMID: 23819760 PMCID: PMC3711933 DOI: 10.1186/1471-2318-13-68] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/24/2013] [Indexed: 12/03/2022] Open
Abstract
Background To enable older people to make decisions about the appropriateness of cardiopulmonary resuscitation (CPR), information is needed about the predictive value of pre-arrest factors such as comorbidity, functional and cognitive status on survival and quality of life of survivors. We systematically reviewed the literature to identify pre-arrest predictors for survival, quality of life and functional outcomes after out-of-hospital (OHC) CPR in the elderly. Methods We searched MEDLINE (through May 2011) and included studies that described adults aged 70 years and over needing CPR after OHC cardiac arrest. Prognostic factors associated with survival to discharge and quality of life of survivors were extracted. Two authors independently appraised the quality of each of the included studies. When possible a meta-analysis of odd’s ratios was performed. Results Twenty-three studies were included (n = 44,582). There was substantial clinical and statistical heterogeneity and reporting was often inadequate. The pooled survival to discharge in patients >70 years was 4.1% (95% CI 3.0-5.6%). Several studies showed that increasing age was significantly associated with worse survival, but the predictive value of comorbidity was investigated in only one study. In another study, nursing home residency was independently associated with decreased chances of survival. Only a few small studies showed that age is negatively associated with a good quality of life of survivors. We were unable to perform a meta-analysis of possible predictors due to a wide variety in reporting and statistical methods. Conclusions Although older patients have a lower chance of survival after CPR in univariate analysis (i.e. 4.1%), older age alone does not seem to be a good criterion for denying patients CPR. Evidence for the predictive value of comorbidities and for the predictive value of age on quality of life of survivors is scarce. Future studies should use uniform methods for reporting data and pre-arrest factors to increase the available evidence about pre arrest factors on the chance of survival. Furthermore, patient-specific outcomes such as quality of life and post-arrest cognitive function should be investigated too.
Collapse
Affiliation(s)
- Esther M M van de Glind
- Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
38
|
van Roeden SE, van Delden JJM. Do-Not-Resuscitate, the Next Generation: VF-Only. J Am Geriatr Soc 2013; 61:307-8. [DOI: 10.1111/jgs.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| |
Collapse
|
39
|
Akahane M, Tanabe S, Koike S, Ogawa T, Horiguchi H, Yasunaga H, Imamura T. Elderly out-of-hospital cardiac arrest has worse outcomes with a family bystander than a non-family bystander. Int J Emerg Med 2012; 5:41. [PMID: 23137233 PMCID: PMC3520782 DOI: 10.1186/1865-1380-5-41] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND A growing elderly population along with advances in equipment and approaches for pre-hospital resuscitation necessitates up-to-date information when developing policies to improve elderly out-of-hospital cardiac arrest (OHCA) outcomes. We examined the effects of bystander type (family or non-family) intervention on 1-month outcomes of witnessed elderly OHCA patients. METHODS Data from a total of 85,588 witnessed OHCA events in patients aged ≥65 years, which occurred from 2005 to 2008, were obtained from a nationwide population-based database. Patients were stratified into three age categories (65-74, 75-84, ≥85 years), and the effects of bystander type (family or non-family) on initial cardiac rhythm, rate of bystander cardiopulmonary resuscitation (CPR), and 1-month outcomes were assessed. RESULTS The overall survival rate was 6.9% (65-74 years: 9.8%, 75-84 years: 6.9%, ≥85 years: 4.6%). Initial VF/VT was recorded in 11.1% of cases with a family bystander and 12.9% of cases with a non-family bystander. The rate of bystander CPR was constant across the age categories in patients with a family bystander and increased with advancing age categories in patients with a non-family bystander. Patients having a non-family bystander were associated with significantly higher 1-month rates of survival (OR: 1.26; 95% CI: 1.19-1.33) and favorable neurological status (OR: 1.47; 95% CI: 1.34-1.60). CONCLUSIONS Elderly patient OHCA events witnessed by a family bystander were associated with worse 1-month outcomes than those witnessed by a non-family bystander. Healthcare providers should consider targeting potential family bystanders for CPR education to increase the rate and quality of bystander CPR.
Collapse
Affiliation(s)
- Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | | | | | | | | | | | | |
Collapse
|
40
|
Age Alone May Not Predict Immediate Survival Outcome in Sudden and Unexpected In-hospital Cardiac Arrest. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
41
|
Pleskot M, Hazukova R, Stritecka H, Cermakova E. Five-year survival of patients after out-of-hospital cardiac arrest depending on age. Arch Gerontol Geriatr 2011; 53:e88-92. [DOI: 10.1016/j.archger.2010.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/23/2010] [Accepted: 06/25/2010] [Indexed: 11/28/2022]
|
42
|
Out-of-hospital cardiac arrests in the older age groups in Melbourne, Australia. Resuscitation 2011; 82:398-403. [DOI: 10.1016/j.resuscitation.2010.12.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 11/02/2010] [Accepted: 12/15/2010] [Indexed: 11/19/2022]
|
43
|
Arrich J, Zeiner A, Sterz F, Janata A, Uray T, Richling N, Behringer W, Herkner H. Factors associated with a change in functional outcome between one month and six months after cardiac arrest: a retrospective cohort study. Resuscitation 2009; 80:876-80. [PMID: 19524349 DOI: 10.1016/j.resuscitation.2009.04.045] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 04/09/2009] [Accepted: 04/21/2009] [Indexed: 11/16/2022]
Abstract
AIM OF THE STUDY The appropriate time point of evaluation of functional outcome in cardiac arrest survivors remains a matter of debate. In this cohort study we posed the hypothesis that there are no significant changes in Cerebral Performance Categories (CPC) between one month and six months after out-of hospital cardiac arrest. If changes were present we aimed to identify reasons for these changes. METHODS Based on a cardiac arrest registry, a potential change in CPC and mortality between one month and six months after cardiac arrest was analysed. Variables that were associated with these changes were identified. RESULTS Thirty percent of 681 patients showed a significant change in functional outcome and mortality between one month and six months after out-of hospital cardiac arrest, 12% improved in CPC, 1% deteriorated, 17% died. The only factor that was associated with an improvement in CPC in the multivariate analysis was time to restoration of spontaneous circulation (ROSC) (RRR 1.04, 95% CI 1.01-1.06, per minute). We could not find any significant factors associated with a deterioration of CPC. Factors that were associated with mortality were age (RRR 1.03, 95% CI 1.01-1.06) and ventricular fibrillation as initial cardiac rhythm (RRR 0.34, 95% CI 0.16-0.71). CONCLUSIONS There is a relevant change of functional outcome even one month after out-of hospital cardiac arrest. Especially when studies compare patient groups with unequal arrest times, and an unequal distribution of initial cardiac rhythms a follow-up period longer than one month should be considered for the final outcome evaluation after cardiac arrest.
Collapse
Affiliation(s)
- Jasmin Arrich
- Universitätsklinik für Notfallmedizin, Medical University of Vienna, Währinger Gürtel 18-20/6D, 1190 Wien, Austria
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Chang WH, Huang CH, Chien DK, Su YJ, Lin PC, Tsai CH. Factors Analysis of Cardiopulmonary Resuscitation Outcomes in the Elderly in Taiwan. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(09)70016-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
45
|
Herlitz J, Svensson L, Engdahl J, Silfverstolpe J. Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm. Resuscitation 2008; 76:31-6. [PMID: 17709164 DOI: 10.1016/j.resuscitation.2007.06.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 06/18/2007] [Accepted: 06/27/2007] [Indexed: 11/17/2022]
Abstract
AIM To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. PATIENTS All the patients included in the Swedish OHCA registry between 1990 and 2005 in whom resuscitation was attempted, who were found in a non-shockable rhythm and where either the OHCA was witnessed by a bystander or was not witnessed. RESULTS In all, 22,465 patients fulfilled the inclusion criteria. Their mean age was 67 years, 32% were women, 57% were witnessed, 64% had a cardiac aetiology, 71% occurred at home and 34% received bystander cardiopulmonary resuscitation (CPR). Survival to 1 month was 1.3%. The following were independently associated with an increased chance of survival: 1/Decreasing age, 2/Witnessed arrest, 3/Bystander CPR, 4/Cardiac arrest outside home, 5/Shorter ambulance response time and 6/Need for defibrillatory shock. If these six criteria were fulfilled (age and ambulance response time below the median), survival to 1 month increased to 12.6%. If no criteria were fulfilled, survival was 0.15%. CONCLUSION The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.
Collapse
Affiliation(s)
- J Herlitz
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | | | |
Collapse
|
46
|
Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation 2007; 116:2908-12. [PMID: 18071077 DOI: 10.1161/circulationaha.107.710194] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND We sought to compare the 1-month survival rates among patients after out-of-hospital cardiac arrest who had been given bystander cardiopulmonary resuscitation (CPR) in relation to whether they had received standard CPR with chest compression plus mouth-to-mouth ventilation or chest compression only. METHODS AND RESULTS All patients with out-of-hospital cardiac arrest who received bystander CPR and who were reported to the Swedish Cardiac Arrest Register between 1990 and 2005 were included. Crew-witnessed cases were excluded. Among 11,275 patients, 73% (n=8209) received standard CPR, and 10% (n=1145) received chest compression only. There was no significant difference in 1-month survival between patients who received standard CPR (1-month survival=7.2%) and those who received chest compression only (1-month survival=6.7%). CONCLUSIONS Among patients with out-of-hospital cardiac arrest who received bystander CPR, there was no significant difference in 1-month survival between a standard CPR program with chest compression plus mouth-to-mouth ventilation and a simplified version of CPR with chest compression only.
Collapse
Affiliation(s)
- Katarina Bohm
- Department of Cardiology and Stockholm Prehospital Centre, Karolinska Institute, South General Hospital, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
47
|
Keenan SP, Dodek P, Martin C, Priestap F, Norena M, Wong H. Variation in length of intensive care unit stay after cardiac arrest: where you are is as important as who you are. Crit Care Med 2007; 35:836-41. [PMID: 17255864 DOI: 10.1097/01.ccm.0000257323.46298.a3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether hospital site is independently associated with length of intensive care unit (ICU) stay in those patients who die in hospital after experiencing a cardiac arrest. DESIGN Retrospective cohort study. SETTING Thirty-one Canadian ICUs, all but one being members of the Critical Care Research Network. PATIENTS All patients admitted to these ICUs after resuscitation from a cardiac arrest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Retrospective analysis of prospectively collected clinical data. Using gamma regression with ICU length of stay as the dependent variable, we found the following variables to be independently associated with ICU length of stay: age, gender, Acute Physiology and Chronic Health Evaluation II score, Glasgow Coma Scale score, hospital size, and hospital site. CONCLUSIONS In this cohort of patients admitted to ICU after cardiac arrest, hospital site was strongly associated with ICU length of stay after controlling for patient-specific factors. Variation in processes of care among ICUs may point to opportunities for improvement.
Collapse
Affiliation(s)
- Sean P Keenan
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Herlitz J, Svensson L, Engdahl J, Angquist KA, Silfverstolpe J, Holmberg S. Association between interval between call for ambulance and return of spontaneous circulation and survival in out-of-hospital cardiac arrest. Resuscitation 2006; 71:40-6. [PMID: 16945468 DOI: 10.1016/j.resuscitation.2006.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 03/02/2006] [Accepted: 03/10/2006] [Indexed: 11/24/2022]
Abstract
AIM To describe the association between the interval between the call for ambulance and return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest. PATIENTS All patients suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started, included in the Swedish Cardiac Arrest Registry (SCAR) for whom information about the time of calling for an ambulance and the time of ROSC was available. RESULTS Among 26,192 patients who were included in SCAR and were not witnessed by the ambulance crew, information about the time of call for an ambulance and the time of ROSC was available in 4847 patients (19%). There was a very strong relationship between the interval between call for an ambulance and ROSC and survival to one month. If the interval was less than or equal to 5 min, 47% survived to one month. If the interval exceeded 30 min, only 5% (n = 35) survived to one month. The vast majority of the latter survivors had a shockable rhythm either on admission of the rescue team or at some time during resuscitation. CONCLUSION Among patients who have ROSC after an out-of-hospital cardiac arrest, there is a very strong association between the interval between the call for ambulance and ROSC and survival to one month. However, even if this delay is very long (> 30 min after calling for an ambulance), a small percentage will ultimately survive; they are mainly patients who at some time during resuscitation have a shockable rhythm. The overall percentage of patients for whom CPR continued for more than 30 min who are alive one month later can be assumed to be extremely low.
Collapse
Affiliation(s)
- J Herlitz
- Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
| | | | | | | | | | | |
Collapse
|
50
|
Arrich J, Sterz F, Fleischhackl R, Uray T, Losert H, Kliegel A, Wandaller C, Köhler K, Laggner AN. Gender modifies the influence of age on outcome after successfully resuscitated cardiac arrest: a retrospective cohort study. Medicine (Baltimore) 2006; 85:288-294. [PMID: 16974213 DOI: 10.1097/01.md.0000236954.72342.20] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Age is an important risk factor for mortality and unfavorable outcome after successfully resuscitated cardiac arrest. Other risk factors may interact with this relationship. We conducted the current study to quantify the influence of age on mortality and unfavorable neurologic outcome of patients surviving out-of-hospital cardiac arrest, and to determine the role of other confounding variables. This study was based on a cardiac arrest registry comprising all patients with witnessed out-of-hospital cardiac arrest of cardiac origin after successful resuscitation admitted to a department of emergency medicine between September 1991 and December 2004. We assessed the association between age and mortality and the degree of neurologic impairment, adjusting for multiple risk factors. We tested for interaction between age and all other risk factors with outcome. With each year of age the adjusted odds ratio for in-hospital death increased by 1.05 (95% confidence interval [CI], 1.04-1.07), and the adjusted odds ratio for an unfavorable neurologic outcome increased by 1.04 (95% CI, 1.03-1.06). Interaction between age and sex was present, and the analysis was stratified to sex. For men we found a steep risk increase for death and unfavorable outcome after being resuscitated from cardiac arrest, with the highest risk in the oldest age quartile. For women we observed only a slight risk increase for death and almost no risk increase for unfavorable outcome. Age is a strong independent risk factor for mortality and neurologic impairment after successfully resuscitated cardiac arrest. The risk increase with advancing age is much greater in men than in women. Therefore, in women, the influence of age on prognosis after cardiac arrest may not be very important, while in men it still plays an important role. This should be considered especially when treating successfully resuscitated women and discussing the prognosis with the medical team or the patient's family.
Collapse
Affiliation(s)
- Jasmin Arrich
- From Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|