Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS.

The role of extracorporeal membrane oxygenation (ECMO) as part of cardiopulmonary resuscitation (ECPR) among the elderly is not clearly defined. We sought to query the international Extracorporeal Life Support Organization (ELSO) registry database to investigate the use of ECMO support among the elderly. The objective of this study was to investigate survival to hospital discharge among the elderly supported on ECMO. The ELSO registry database was queried, identifying all elderly patients (>65 years of age) supported on ECMO for ECPR from 1998 to 2009. The primary outcome variable was survival to hospital discharge. Clinical characteristics between survivors and nonsurvivors were compared using univariate analysis. Ninety-nine elderly patients requiring ECPR were identified from the ELSO registry for the study period. The median age of the cohort was 70 years (range 65-86 years). The median admission to time on ECMO was 32 hours (range 1-998 hours), median time on ECMO was 69 hours (range 1-459 hours), and median time off to discharge for survivors was 587 hours (range 3-2,166 hours). Overall, survival at hospital discharge was 22.2% (22/99). No significant differences were noted between survivors and nonsurvivors for demographics, secondary diagnoses, pre-ECMO variables, complications on ECMO, as well as the type and duration of ECMO support. Among listed comorbidities, only the presence of pre-ECMO acute renal failure was significantly more frequent in nonsurvivors compared with survivors (14 vs. 0; p = 0.04). Survival to hospital discharge among the elderly supported on ECMO is lower than that for younger adult patients (28.7% vs. 40.0%). However, it is higher than that after conventional CPR (17%), suggesting that age should not be a bar against consideration for the use of ECMO in older patients but should be considered on a case-by-case basis.

Objectives To investigate national trends in percutaneous endoscopic gastrostomy (PEG) tube placement for hospitalized elderly patients from 1993to 2003. Methods Retrospective analysis of patients ≥65 years of age with PEG tube placement from 1993 to 2003 from the Nationwide Inpatient Sample (NIS) database was utilized to calculate PEG placement rates per 1000 people. Results Placement of PEG tube increased by 38% in elderly patients during the study period, from 2.71 procedures during hospitalization per 1000 people to 3.75 procedures during hospitalization per 1,000 people. Placement of PEG tube in patients with Alzheimer’s dementia doubled (5%–10%) over the study period. Conclusion Over a 10-year period, PEG tube use in hospitalized elderly patients increased significantly. More importantly, approximately 1 in 10 PEG tube placements occurred in patients with dementia.