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Geriatric Experience Following Cardiac Arrest at Six Interventional Cardiology Centers in the United States 20062011: Interplay of Age, Do-Not-Resuscitate Order, and Outcomes*

Seder, David B. MD1,2; Patel, Nainesh MD3; McPherson, John MD4; McMullan, Paul MD5; Kern, Karl B. MD6; Unger, Barbara RN1,7; Nanda, Sudip MD3; Hacobian, Melkon MD2; Kelley, Michael B. MD4; Nielsen, Niklas MD, PhD1,8; Dziodzio, John BA2; Mooney, Michael MD7; for the International Cardiac Arrest Registry (INTCAR)-Cardiology Research Group

Critical Care Medicine:
doi: 10.1097/CCM.0b013e3182a26ec6
Clinical Investigations
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.

Author Information

1International Cardiac Arrest Registry (INTCAR), Portland, ME; and Lund, Sweden.

2Department of Critical Care Services, Maine Medical Center, Portland, ME.

3Division of Cardiology, Lehigh Valley Health Network, Allentown, PA.

4Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN.

5Division of Cardiology, Ochsner Medical Center, New Orleans, LA.

6Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, AZ.

7Minneapolis Heart Institute, Minneapolis, MN.

8Department of Clinical Sciences, Lund University, Lund, Sweden.

* See also p. 453.

Dr. McPherson consulted for CardioDX (Modest). Dr. Kern consulted for Zoll Medical. Dr. Kern is a member of a Science Advisory Board for Zoll. Dr. Nielsen’s institution received grant support from the Swedish Heart and Lung Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: sederd@mmc.org

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins