CARDIOPULMONARY RESUSCITATION OF OLD PEOPLE

doi:10.1016/S0140-6736(83)90244-1

The Lancet

Volume 322, Issue 8344, 30 July 1983, Pages 267-269

https://doi.org/10.1016/S0140-6736(83)90244-1 Get rights and content

Abstract

In a prospective study, cardiopulmonaryresuscitation was attempted in 52 elderly patients (mean age 75·6 yr, range 64-91). Of 14 who were resuscitated initially, 5 died in the first week. Of the 9 still alive at one month (mean age 75·3, range 65-85), none seemed to have adverse effects, in terms of mental status or physical dependence, from the episode of cardiac arrest and resuscitation; 7 had left hospital. The nature of the cardiac dysrhythmia is a strong predictor of outcome. Age, sex, and time of arrest are not.

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Cited by (92)

Factors analysis of cardiopulmonary resuscitation outcomes in the elderly in Taiwan
2009, International Journal of Gerontology
Performing cardiopulmonary resuscitation (CPR) can save countless lives, but its use is rather controversial in elderly patients. Some researchers believe that there is an inverse ratio between the success of CPR and the age of the patient, while others believe that the uniqueness of each case and existing comorbidities are more important factors. CPR can result in severe injury for patients. Therefore, physicians often face a dilemma between rational and moral decisions when dealing with older patients suffering from cardiac arrest. The solution to this problem rests on the determination of whether CPR will benefit the patient. This analysis, supported by a literature review and a review of the outcomes of CPR, considered different factors in elderly patients, including age, sex, prehospital emergency medical service, preexisting disease, witnessed cardiac arrest, initial arrest electrocardiogram rhythm, CPR locations, and ethics. Quality of life and the cost of medical care for the elderly affect the benefit analysis of CPR. Indeed, a large amount of money is spent on elderly CPR patients who remain in critical condition before finally dying in the hospital. Factors contributing to decisions to resuscitate also include post-resuscitation quality of life, and the will of patients, families and doctors. In short, patient age is not a barrier to performing CPR. However, to achieve the best outcome of CPR, one must consider the disease diagnosis of elderly patients as a useful reference to help improve medical care for this group.
Outcome of non-traumatic out-of-hospital cardiac arrest in the elderly
2008, International Journal of Gerontology
Because of changes in lifestyle and the advancement of medical science, human life expectancy in Taiwan is longer than it used to be. Since 1993, we have had an “aging population”, i.e., the proportion of the elderly population is greater than 7% of the general population and is increasing over time. However, to our knowledge, no study of the outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly has been performed in Taiwan. This study was, therefore, undertaken to identify both the outcomes of these occurrences and the factors that influenced them.
This was a retrospective study. The characteristics of 299 nontraumatic OHCA patients (elderly/adult ratio, 198:101), who received cardiopulmonary resuscitation upon arrival at the emergency department (ED) between January 1, 2005 and December 31, 2005 were reviewed. The group was split between “elderly patients” aged 65 or over and “adult patients” aged 18 to 64. The outcome measurements included return of spontaneous circulation (ROSC) at the ED, survival to hospital admission, and survival to hospital discharge with full neurologic function.
The overall survival rate of patients was 7.4%. Of the 198 elderly patients, 85 (42.9%) had ROSC, 50 (25.3%) survived to admission and 12 (6.1%) survived to hospital discharge. In comparison, of the 101 adult patients, 32 (31.7%) had ROSC, 21 (20.8%) survived to admission and 10 (9.9%) survived to hospital discharge. The differences in outcomes between the two groups were not statistically significant. In the subgroup of patients who had ROSC at the ED, the adult group had a higher rate of survival to hospital discharge than the elderly (31.3% vs. 14.1%; p = 0.035); but in multivariate analysis, only the initial ventricular fibrillation/ventricular tachycardia rhythm predicted survival rate (odds ratio, 7.912; p = 0.007). The factor that predicted ROSC was witnessed arrest. Factors that predicted hospital discharge included witnessed arrest and shorter duration of resuscitation in the ED. Post-resuscitation neurologic outcomes of the survivors showed no significant difference between the two groups.
It is rational and necessary to aggressively resuscitate in cases of cardiac arrest among the elderly, because their age did not significantly decrease their survival rate or worsen their post-resuscitation neurologic outcomes, compared with non-elderly patients. All the elderly survivors studied were witnessed arrest cases, with return of circulation within 20 minutes at the ED.
Reliability testing and update of the Resuscitation Predictor Scoring (RPS) Scale
2007, Resuscitation
Citation Excerpt :
With a larger sample it is likely that survival will increase in every other row of these VT/VF groupings; we have therefore included survival estimates of 25–35% as a guide for clinicians. This latest RPS scale retains its high content and face validity in that survival rates are similar to other studies 10–19 and the key predictors of survival are supported in other work, for example age,10,11,20–24 primary mode of arrest,11,25 primary arrhythmia 9–11,13,17,20,22,25,27–30 and duration of resuscitation11,20,23,31,32. In fact, even though a limited number of variables were selected for use in the scale the original regression analysis predicted an overall survival accuracy of 90%.1
The purpose of this study was to test the reliability of the Resuscitation Predictor Scoring (RPS) Scale1 (Appendix A), a survival prediction nomogram designed to aid resuscitation termination decisions during a resuscitation attempt.
Bivariate comparisons of predictors of survival and survival rates between the primary RPS Scale data set (1993–2000) and a secondary data set (2000–2003). A total of 2121 patients were included in the study.
Comparisons of the two sets of data showed an increase in resuscitation attempts for patients ≥80 years (p < 0.001); an increase in pulseless electrical activity (PEA) (p = 0.01) and an increase in the duration of arrests (p = 0.012). However, in relation to the RPS Scale there were no statistical differences in survival between any of the sub groups demonstrating the reliability of the nomogram.
The final updated RPS Scale demonstrates predicted survival rates 15 min into a resuscitation attempt. These can be poor and suggest that it is an acceptable point at which to first consider termination (where there has been no ROSC). The RPS Scale has demonstrated reliability and validity, but can only be a guide for the cessation of resuscitation.
Resuscitation in the Hospital: Circadian Variation of Cardiopulmonary Arrest
2007, American Journal of Medicine
Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in cardiopulmonary arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge.
A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented.
Significant circadian variation was found at 1 hour (P = .01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P = .03) and asystole (P = .01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P = .002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P = .003 and P <.0001). In multivariate analysis, only rhythm remained significant.
Circadian variation of cardiopulmonary arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.
Ethics
2007, Primary Care Geriatrics: A Case-Based Approach
Resuscitation of the Elderly
2006, Emergency Medicine Clinics of North America
Citation Excerpt :
Contrary to older studies, more recent studies have reported more favorable results. Most studies have shown a hospital discharge survival rate ranging from 10% to 29%, and shown age not to be a significant determinant of survival [7–16]. The presence of ventricular tachycardia/ventricular fibrillation (VT/VF) substantially improves these rates, while relatively few patients who demonstrate asystole survive.

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Hospital PracticeCARDIOPULMONARY RESUSCITATION OF OLD PEOPLE

Abstract

Lancet

Lancet

Fatal heart attack and successful defibrillation; new concepts in coronary artery disease

JAMA

Closed-chest cardiac massage

JAMA

Cardiopulmonary resuscitation in a teaching hospital

Anaesthesia

Hospital Practice
CARDIOPULMONARY RESUSCITATION OF OLD PEOPLE