Age Alone May Not Predict Immediate Survival Outcome in Sudden and Unexpected In-hospital Cardiac Arrest

Abstract

Background: It is unknown whether outcome after unexpected in-hospital cardiopulmonary resuscitation (CPR) differs in the elderly (≥ 65 years) compared to the non-elderly (< 65 years). This study aimed to compare the rate of sustained return of spontaneous circulation (ROSC) in the elderly and those < 65 years old experiencing unexpected in-hospital cardiac arrest (CA). Methods: We conducted a retrospective chart review of all resuscitation attempts in cases that involved 65 years of age or older patients following in-hospital CA, in a medical center during a 3-year study period (January 2007 to December 2009). Patients were stratified a priori by type of CA (sudden and expected) and age groups (< 65 years and ≥ 65 years). The variables that lead to sustained ROSC and those that did not lead to sustained ROSC were analyzed. Logistic regression analyses were calculated separately to identify independent risk factors for ROSC. Results: Altogether, 283 unexpected CA were analyzed and among these 191 patients were ≥ 65 years old. There were no significant differences in terms of the rate of sustained ROSC between unexpected and expected CA regardless of age. Less than half of the patients died immediately; an initial ROSC rate as high as 72% for unexpected CA was established in those < 65 years old and the elderly (p=0.998). However, underlying diseases could affect the rate of sustained ROSC in geriatric patients with unexpected in-hospital CA. Conclusions: Selected geriatric hospitalized patients may benefit from a short resuscitation attempt. Initial successful resuscitation rate was not inferior to those < 65 years, indicating that initiation of resuscitation should not be affected by age. Patients who are unlikely to benefit from CPR should be identified at or during hospital admission and the possibility of DNR (Do Not Resuscitate) orders should be discussed to avoid inappropriate treatment and potential patient suffering.

Keywords

• cardiopulmonary resuscitation
• geriatric
• return of spontaneous circulation