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Out-of-Hospital Cardiac Arrest in Octogenarians and Nonagenarians
Catherine Kim, MD, MPH;
Linda Becker, MA;
Mickey S. Eisenberg, MD, PhD
Arch Intern Med. 2000;160:3439-3443.
Background Studies of elderly patients who have out-of-hospital cardiac arrest have contradictory results. The studies usually define elderly patients as those older than 70 years, and include relatively few octogenarians and nonagenarians.
Objectives To compare the survival after out-of-hospital cardiac arrest of octogenarians, nonagenarians, and younger patients and to determine the influence of age on survival after adjusting for factors known to influence out-of-hospital cardiac arrest outcome.
Methods We conducted a retrospective cohort study in suburban King County, Washington, on 5882 patients who had out-of-hospital cardiac arrest from presumed cardiovascular disease between January 1, 1987, and December 31, 1998, and who received cardiopulmonary resuscitation from bystanders, emergency medical technicians, or both. The main outcome measure was survival to hospital discharge.
Results In patients who had out-of-hospital cardiac arrest due to a cardiac cause, younger patients had higher hospital discharge rates than octogenarians, who in turn had higher hospital discharge rates than nonagenarians (19.4% vs 9.4% vs 4.4%; P<.001). However, survival to hospital discharge improved significantly for younger patients, octogenarians, and nonagenarians who had ventricular fibrillation or pulseless ventricular tachycardia (36% vs 24% vs 17%; P<.001). After multiple logistic regression analysis controlling for other factors, increased age was weakly associated with decreased survival to hospital discharge (odds ratio, 0.92; 95% confidence interval, 0.85-0.99).
Conclusions Octogenarians and nonagenarians have lower survival to hospital discharge than younger patients, but age is a much weaker predictor of survival than other factors such as initial cardiac rhythm. Decisions regarding resuscitation should not be based on age alone.
From the Robert Wood Johnson Clinical Scholars Program (Dr Kim) and the Division of Emergency Medicine, Department of Medicine (Dr Eisenberg), University of Washington, Seattle; and the Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle, King County Department of Health (Ms Becker and Dr Eisenberg).
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