Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

BackgroundOut-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.ObjectivesWe aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥ 80) to assess whether resuscitation and post resuscitation care should be avoided.MethodsDuring 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)).Results2509 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.ConclusionOHCA 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.