Cardiopulmonary resuscitation of older, inhospital patients: Immediate efficacy and long-term outcome

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Abstract
Objective To determine the independent effect of advancing age on prognosis after cardiopulmonary resuscitation (CPR). Design and Setting Retrospective analysis of clinical records of patients who received CPR in a geriatric department equipped with an intensive care unit. Patients A total of 245 patients (146 men, 99 women; mean age, 70 ± 11 yrs) received CPR. Of these, 221 had a cardiocirculatory arrest (CA) in the intensive care unit and 24 had a CA in the general ward of the department. Acute myocardial infarction was the most frequent admission diagnosis. Interventions CPR according to standard guidelines in all cases. Measurements and Main Results Immediate, short-term (hospital discharge), and long-term (median follow-up, 31.5 months; range, p < .05) and, less frequently, ventricular tachycardia/fibrillation (VT/VF) as a cause of CA. VT/VF bore the lowest immediate mortality rate (19/104; 18.3%) as compared with asystole/complete heart block (66/102; 64.7%) or pulseless electrical activity (40/49; 81.6%;p < .001). Acute myocardial infarction, acute heart failure, hypotension, and occurrence of CA in the intensive care unit were also univariate predictors of unfavorable, immediate prognosis. However, in a multiple logistic analysis model, the mechanism of CA (asystole/complete heart block or pulseless electrical activity vs. VT/VF), acute myocardial infarction, heart failure, and hypotension were independent predictors of unfavorable immediate prognosis, whereas advancing age was not. Similarly, after initially successful CPR, short-term survival was independently associated with acute myocardial infarction, hypotension before CA, initial rhythm at CA, and need for mechanical ventilatory support after CPR, but not with age. Long-term survival (42 patients; 17.2% of the original cohort; median survival, 32 months) was also independent of age, whereas it was negatively associated with heart failure. Conclusion Immediate, short- and long-term prognosis after inhospital CPR is independent of age, at least when possible confounders are simultaneously taken into account.