Determinants of outcome and long-term survival are unknown in elderly
patients successfully resuscitated after out-of-hospital cardiac arrest
. Our aim was to identify factors associated with short- and long-term neurologic outcome in such patients.
Retrospective cohort study.
Tertiary hospital in Paris, France.
Patients aged over 75 admitted in our ICU after an out-of-hospital cardiac arrest
between 2000 and 2009.
Measurements and Main Results:
Two hundred twenty-five patients were included in the study. Fifty-seven patients (25.3%) had a good neurologic outcome at ICU discharge (Cerebral Performance Category 1–2). By multivariate logistic regression analysis, factors associated with good short-term outcome were time from collapse to cardiopulmonary resuscitation less than or equal to 3 minutes (odds ratio = 4.06; 95% CI, 1.49–11.09, p
= 0.006) and blood lactate level less than or equal to 5.1 mmol/L (odds ratio = 3.30; 95% CI, 1.05–10.39, p
= 0.04), but age less than or equal to 79.5 years and use of induced hypothermia were not. Long-term survivors were assessed for cognitive and functional status (using Cerebral Performance Category and Overall Performance Category scales), and their survival was compared with a large community–based cohort of participants over 75 years. The 1-year survival of ICU survivors (mean follow-up, 28.4 mo) was 69.3% (95% CI, 55.8–79.5) as compared with 95.3% (95% CI, 93.3–97.3) in the control community–based cohort (p
< 0.001), resulting in a standardized mortality ratio of 3.49 (95% CI, 2.42–4.85). By multivariate Cox proportional hazard model, factors associated with long-term survival were initial shockable rhythm (hazard ratio = 1.41; 95% CI, 1.01–1.96; p
= 0.04), epinephrine cumulate dose less than or equal to 3 mg (hazard ratio = 1.48; 95% CI, 1.06–2.08; p
= 0.02), and blood lactate level less than or equal to 5.1 mmol/L (hazard ratio = 2.11; 95% CI, 1.5–2.96; p
< 0.001). When available at end of follow-up, 91% and 74% of the patients were classified Cerebral Performance Category 1 and Overall Performance Category 1, respectively.
Neurologic outcome in successfully resuscitated elderly
patients depends on cardiac arrest characteristics rather than age. Short-term survival is 25% with acceptable long-term outcome among survivors.